Heart & Vascular | Prevention | Women's Health
September 7, 2017

SCAD: What women should know about this cause of heart attacks

by What all women should know about this cause of heart attacks

Spontaneous coronary artery dissection is an important cause of heart attack for young women to understand.

 

When most of us think about heart attack, we think about the risk factors: older age, smoking, high blood pressure, diabetes, high cholesterol and our family histories. We have been taught well because the vast majority of heart attacks occur in people who have one, or more likely, several of these risk factors. The difficulty comes when a person suffers a heart attack but doesn’t have these traditional risk factors.

As a means of introduction to an uncommon cause of heart attack, I would like to share a common scenario I frequently encounter in the clinic. A woman in her 40s, otherwise healthy, presents to the emergency department with chest discomfort and severe fatigue. She also has some pain going down her left arm and through the back. She is diagnosed with anxiety, heartburn, or a muscle strain and is discharged. She returns later the same day with crushing chest pain and is diagnosed with a heart attack. She undergoes a coronary angiogram and is diagnosed with spontaneous coronary artery dissection.

What is spontaneous coronary artery dissection? The heart is a muscle which, like all the other muscles in the body, requires a blood supply to perform its work. The blood supply to the heart muscle is supplied through the coronary arteries. When the inner layer of the coronary artery tears away from the outer layer, it can cause a sudden, severe blockage which can lead to chest pain and heart attack. When this tearing of the artery wall occurs without apparent cause, it is called spontaneous coronary artery dissection. This is an uncommon cause of heart attack but when it does occur, it tends to affect women who are in their 40s and 50s and who do not have the traditional risk factors for heart attack.

The top 5 facts about spontaneous coronary artery dissection:

1. Most patients with it present with heart attack.

Note: Heart attack in women is known to present differently, but the most common symptom of heart attack from spontaneous coronary artery dissection is chest pain. Other symptoms include shortness of breath, arm or jaw pain, sweating, severe and unexplained fatigue.

2. The “typical” patient with spontaneous coronary artery dissection is a woman in her 40s and 50s without the usual risk factors for heart attack.

Note: Though men can suffer heart attack from spontaneous coronary artery dissection, 90 percent of these patients are women and most do not have the traditional risk factors for heart disease. This is one reason their diagnosis may be delayed. The condition is actually the most common cause of heart attack in patients around the time of pregnancy, responsible for an estimated 40 percent of heart attacks during that time.

3. The cause is unknown but it is known to be associated with other vascular diseases, including fibromuscular dysplasia and brain aneurysm.

Note: Patients who have suffered heart attack from spontaneous coronary artery dissection should talk to their doctors about further testing to identify underlying vascular diseases, which may provide a clue into the cause. Importantly, there may not be any symptoms from brain aneurysm and patients should discuss with their doctors about further testing to detect a silent aneurysm should treatment be necessary.

4. Treatment for heart attack from spontaneous coronary artery dissection differs from heart attack due to cholesterol plaque.

Note: Heart stents and coronary artery bypass surgery remain valuable treatments for the patient with heart attack from spontaneous coronary artery dissection, however, unlike blockages caused by cholesterol plaque, most blockages caused by spontaneous coronary artery dissection will heal on their own. Patients who have evidence of continued heart damage from heart attack require heart stents and bypass surgery but medical management is the treatment of choice in patients who are otherwise stable. Interventional cardiologists and cardiothoracic surgeons determine the best option at the time of diagnosis.

5. Though it is an uncommon disease, these patients do not have to suffer alone.

Note: Several support groups are available online through Facebook and other social media platforms. Organizations such as SCAD Alliance (www.scadalliance.org), a non-profit patient advocacy group for these survivors, bring patients together to educate themselves and their providers and to support research throughout the United States.

It is startling to think that an otherwise healthy young person in the prime of her life could be a heart attack survivor, but as I see in my clinic every week, spontaneous coronary artery dissection can be a life-changing event. It is the duty of the cardiologist to be able to diagnose this uncommon cause of heart attack, and patients should be aware of the signs of heart attack and not ignore them should they occur. I am hopeful that ongoing collaborative research will help us to better diagnose and ultimately prevent this important cause of heart attack.

 

Esther S.H. Kim, MD, MPH is a cardiologist and vascular medicine specialist who focuses on the care of patients with uncommon arterial disorders. She is an Associate Professor of Medicine and the Director of the Arteriopathy Clinic at the Vanderbilt Heart and Vascular Institute. She has several ongoing research studies on SCAD and FMD and currently serves as the Chair of the Scientific Advisory Board for SCAD Alliance.

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7 thoughts on “SCAD: What women should know about this cause of heart attacks”

  1. Mary richardson says:

    Thank you this info. I’m a SCAD survivor. My scad was 3mis ago. I’m different in that I am a 66 yr old woman.-basically healthy w/no other heart disease factors. I only had an ache down the middle of my chest & some weakness in my shoulders- but I knew something was very wrong. I was given nitro in ambulance & doctor thinks that may have re-opened my artery some. I had excellent care from my Univerdity of Wisconsin cardiologist.
    I’m very interested in the symposium but cannot attend this year. Are these held every year?

    1. Esther Kim says:

      Hi Mary, thank you for sharing your story and wonderful to hear of the great care you have received. This symposium was made possible by some generous donors and if there is interest and funding, we will certainly consider repeating the meeting in the future. I am working with SCAD Alliance to hopefully make these meetings possible across the country so stay tuned!

  2. Lisa Kaiser says:

    Thank you, Dr Kim, for all the time, dedication, & expertise you are putting into researching SCAD & bringing awareness! Your work will certainly save lives! It means so much to all of us SCAD survivors! I wish I could come to your symposium, but have a family wedding that day & I live in west central Wisconsin. Are you looking for survivors for your research study? (SCAD survivor 12-17-15)

    1. Esther Kim says:

      Hi Lisa, have a great time at the wedding. It’s so important for SCAD survivors to be connected to family, friends, and other survivors. We have some exciting research projects coming up which I am sure you will be hearing about. Thank you for your willingness to help move the science forward.

  3. anonymous says:

    There are also FMD support groups, as well as a patient biorepository out of Cleveland Clinic, OH. Dr. Heather Gornik is a C.C. vascular specialist, and whose nurse, Pam Mace, was featured some time ago on an episode of Mystery Diagnosis & eventually learning of her FMD.

    1. Esther Kim says:

      Thank you for your comment. Dr Gornik is a dear colleague of mine and she has been instrumental in advancing knowledge in FMD. We will also discuss FMD at the symposium, and I should let folks know that Vanderbilt is now one of the sites for the US FMD Registry. Pam Mace is a hero in my eyes and she had been an inspiration to me in so many ways! I encourage anyone with FMD to go to fmdsa.org and learn more about FMD.

  4. Bridgett Kurtz says:

    I’m a 58 year old woman. My health is good, and I take statins for high cholesterol. In the past couple of months, I’ve experienced periods of time with some mild pain and discomfort in my chest. I sometimes have prolonged periods of palpatations, and have been checked out for that. This past weekend I had some pain around my heart area and found it a little difficult take a good breath. I was concerned for a little while and told my husband what I was feeling “in case I pass out or get worse”. After about 20 minutes, it went away. I felt maybe it was muscular (I had been doing some work that used upper body strength).
    My question: are there tests that can detect something like SCAD? Should I get checked out? I don’t want to run to the emergency room every time I have aches and pain, but I also want to be smart about it.
    Thanks.

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