Table of ContentsView AllTable of ContentsFactsSymptomsCausesComplicationsDiagnosisTreatmentPreventionFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Facts
Symptoms
Causes
Complications
Diagnosis
Treatment
Prevention
Frequently Asked Questions
Read on to understand the risk factors, symptoms, complications, and treatment of SCAD.
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SCAD: The Facts
A dissection is a tear in the inner lining of an artery. Blood can enter the tear and form a clot between layers of the arterial wall. Dissection can happen in arteries throughout the body, such as the aorta, the carotid artery, the cerebral artery, and the coronary arteries. This can ultimately obstruct blood flow to organs, which can lead toserious consequences.
The coronary arteries are the arteries that bring oxygenated blood to the heart. When dissection involves a coronary artery, as in SCAD, the heart muscle is deprived of oxygen and nutrients. As a result, the muscle tissue begins to die orinfarct, meaning a heart attack occurs.
Non-Spontaneous Coronary Artery Dissection
Symptoms of SCAD
Spontaneous coronary artery dissection symptoms can include the following:
Warning SignsSeek immediate medical attention if you develop concerning symptoms, such as chest discomfort and shortness of breath. These are signs of a heart attack, which requires emergency treatment.
Warning Signs
Seek immediate medical attention if you develop concerning symptoms, such as chest discomfort and shortness of breath. These are signs of a heart attack, which requires emergency treatment.
Causes and Risk Factors
The causes of SCAD have not been fully determined, but there are several characteristics that are commonly found in SCAD. A combination of genetics, underlying arterial disorders, inflammation, hormones, and precipitating triggers appear to be responsible.
The following have been associated with SCAD:
In addition to these risk factors, SCAD is also often associated with intense physical or emotionalstress.People with SCAD often have had incidents or events leading up to their symptoms, including strenuous exercise, weight-lifting, vomiting, labor and delivery, or even a straining for a bowel movement.
Potential Complications
As previously discussed, SCAD causes heart attack. As with other forms of heart attack, when blood flow to the heart is restricted, other complications can occur.
When the heart is starved of oxygen, serious arrhythmias (problems with the rate or rhythm of heartbeats) likeventricular tachycardiaandventricular fibrillationcan occur. Loss of consciousness andsudden cardiac deathmay result.
Additionally, during a heart attack from any cause, including SCAD, heart muscle begins to die from lack of oxygen. When enough muscle dies and becomes scarred, the heart will not pump as efficiently, which can lead to heart failure.
SCAD is differentiated from other types of heart attack oncoronary angiography(also known as cardiac catheterization). In this procedure, acardiologistaccesses the coronary arteries with a catheter and visualizes them with X-ray radiation.
Sometimes, more specialized intracoronary imaging is needed during the procedure for a more definitive diagnosis.
Once SCAD is diagnosed, treatment depends on the location and extent of the dissection, as well as symptoms.
Revascularization
When SCAD involves a portion of a coronary artery that supplies a large part of the heart, or when SCAD is causing complications, either placement of a coronary stent or surgery may be necessary.This is known asrevascularization.
How Is Revascularization Performed?
On the other hand, if the involved artery is small, symptoms are controlled, and there are otherwise no complications, a more conservative approach of watching and waiting is generally preferred. This requires observation in the hospital for a few days (since emergency intervention may become necessary early after diagnosis). In many cases, the dissection heals itself over time, and a watch-and-wait approach allows that to happen without imposing the risk of procedures.
Stents vs. Bypass Surgery for Treating Coronary Artery Disease
Medical Therapy
Medications used in the treatment of SCAD include:
How Heart Disease Is Treated
Close follow-up with a cardiologist is essential after a diagnosis of SCAD. A cardiologist will prescribe any necessary heart medications, order any recommended cardiac studies, and answer questions about your condition.
Your cardiologist will also look for underlying causes of SCAD. Screening for FMD with imaging of the arteries elsewhere in the body is often done withcomputed tomography (CT)scans ormagnetic resonance imaging(MRI).Genetic testing is recommended when there is suspicion of an inherited vascular disorder.
Cardiac rehabilitationis a structured program that includes education, monitored exercise, and support from a healthcare team over a period of weeks to months.Talk with your cardiologist before resuming previous exercise levels.
SCAD and PregnancyWomen who have had SCAD should discuss the risks of hormonal contraception and pregnancy with their cardiologist and obstetrician, since these have been associated with SCAD.
SCAD and Pregnancy
Women who have had SCAD should discuss the risks of hormonal contraception and pregnancy with their cardiologist and obstetrician, since these have been associated with SCAD.
In those who have developed heart muscle weakness, medications like beta-blockers and ACE-inhibitors play a role in improving survival.If a stent was placed, antiplatelet medications like aspirin are essential to help keep the stent open. Treating any high blood pressure is also important.
Lastly, studies have shown that up to one in three people with SCAD go on to experience another episode of SCAD in the following decade, so it’s important to pay attention to symptoms and report any changes or concerns to your cardiologist.
When to Seek Emergency Care
Summary
Spontaneous coronary artery dissection (SCAD) is a potentially life-threatening condition that causes heart attack. It can lead to arrhythmias, sudden cardiac death, and heart failure. It is more common in young women and has been associated with pregnancy, hormone use, inflammatory conditions, and certain vascular disorders.
Treating SCAD includes medications, possible revascularization, and close follow-up with a cardiologist for counseling on exercise, pregnancy, and hormone use.
A Word From Verywell
Symptoms of a heart attack should always be taken seriously, even if you are young and otherwise healthy. SCAD is known to disproportionately affect women, particularly young women, so it’s important to be aware of the signs and symptoms.
SCAD is less commonly diagnosed than other causes of heart attack and is also underdiagnosed, so it is difficult to say with certainty how life expectancy is affected. Those who survive hospitalization for SCAD generally do well but have higher rates of heart attacks, mostly related to recurring episodes of SCAD.
Learn MoreHeart Attack Overview
Recovery is highly variable after SCAD. When SCAD is diagnosed, monitoring in the hospital is required for several days. Depending on whether complications develop or surgery is required, recovery can take days or weeks. Cardiac rehab is a structured program involving supervised exercise and counseling that can promote recovery and improve quality of life in SCAD.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hayes SN, Kim ESH, Saw J, et al.Spontaneous coronary artery dissection: current state of the science: a scientific statement from the american heart association.Circulation. 2018;137(19). doi:10.1161/CIR.0000000000000564American Heart Association.Coronary artery dissection: not just a heart attack.University of Ottawa Heart Institute.Spontaneous coronary artery dissection.Tweet MS, Kok SN, Hayes SN.Spontaneous coronary artery dissection in women: what is known and what is yet to be understood.Clin Cardiol. 2018;41(2):203-210. doi:10.1002/clc.22909National Organization for Rare Disorders.Fibromuscular dysplasia.American College of Cardiology.Spontaneous coronary artery dissection: clinical considerations in diagnosis and treatment.Hayes SN, Tweet MS, Adlam D, et al.Spontaneous coronary artery dissection: JACC state-of-the-art review.J Am Coll Cardiol. 2020;76(8):961-984. doi:10.1016/j.jacc.2020.05.084American Heart Association.What is cardiac rehabilitation?Heidenreich PA, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hayes SN, Kim ESH, Saw J, et al.Spontaneous coronary artery dissection: current state of the science: a scientific statement from the american heart association.Circulation. 2018;137(19). doi:10.1161/CIR.0000000000000564American Heart Association.Coronary artery dissection: not just a heart attack.University of Ottawa Heart Institute.Spontaneous coronary artery dissection.Tweet MS, Kok SN, Hayes SN.Spontaneous coronary artery dissection in women: what is known and what is yet to be understood.Clin Cardiol. 2018;41(2):203-210. doi:10.1002/clc.22909National Organization for Rare Disorders.Fibromuscular dysplasia.American College of Cardiology.Spontaneous coronary artery dissection: clinical considerations in diagnosis and treatment.Hayes SN, Tweet MS, Adlam D, et al.Spontaneous coronary artery dissection: JACC state-of-the-art review.J Am Coll Cardiol. 2020;76(8):961-984. doi:10.1016/j.jacc.2020.05.084American Heart Association.What is cardiac rehabilitation?Heidenreich PA, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Hayes SN, Kim ESH, Saw J, et al.Spontaneous coronary artery dissection: current state of the science: a scientific statement from the american heart association.Circulation. 2018;137(19). doi:10.1161/CIR.0000000000000564American Heart Association.Coronary artery dissection: not just a heart attack.University of Ottawa Heart Institute.Spontaneous coronary artery dissection.Tweet MS, Kok SN, Hayes SN.Spontaneous coronary artery dissection in women: what is known and what is yet to be understood.Clin Cardiol. 2018;41(2):203-210. doi:10.1002/clc.22909National Organization for Rare Disorders.Fibromuscular dysplasia.American College of Cardiology.Spontaneous coronary artery dissection: clinical considerations in diagnosis and treatment.Hayes SN, Tweet MS, Adlam D, et al.Spontaneous coronary artery dissection: JACC state-of-the-art review.J Am Coll Cardiol. 2020;76(8):961-984. doi:10.1016/j.jacc.2020.05.084American Heart Association.What is cardiac rehabilitation?Heidenreich PA, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063
Hayes SN, Kim ESH, Saw J, et al.Spontaneous coronary artery dissection: current state of the science: a scientific statement from the american heart association.Circulation. 2018;137(19). doi:10.1161/CIR.0000000000000564
American Heart Association.Coronary artery dissection: not just a heart attack.
University of Ottawa Heart Institute.Spontaneous coronary artery dissection.
Tweet MS, Kok SN, Hayes SN.Spontaneous coronary artery dissection in women: what is known and what is yet to be understood.Clin Cardiol. 2018;41(2):203-210. doi:10.1002/clc.22909
National Organization for Rare Disorders.Fibromuscular dysplasia.
American College of Cardiology.Spontaneous coronary artery dissection: clinical considerations in diagnosis and treatment.
Hayes SN, Tweet MS, Adlam D, et al.Spontaneous coronary artery dissection: JACC state-of-the-art review.J Am Coll Cardiol. 2020;76(8):961-984. doi:10.1016/j.jacc.2020.05.084
American Heart Association.What is cardiac rehabilitation?
Heidenreich PA, Bozkurt B, Aguilar D, et al.2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063
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