Spontaneous Coronary Artery Dissection (SCAD)

What is SCAD?

Spontaneous Coronary Artery Dissection (SCAD) is a tear and/or intramural hematoma formation, which leads to partial or complete occlusion of the coronary artery. It causes blood to build up in the space between the layers of your artery wall causing a decrease in the blood flow or a complete blockage of blood flow to your heart – damaging your heart muscle and heart rhythm. This reduced blood flow could cause a heart attack or cardiac arrest. Angiographically, three types of SCAD have been identified.

Causes of SCAD

The cause of SCAD is still unknown. Some evidence has been shown that a weak arterial wall can lead to a dissection. Possible causes of weakened arterial walls may include: fibromuscular dysphasia (FMD), hormone changes, connective disorders and researchers are looking at our genetics. SCAD has also been linked with recent emotional or physical stress. More research is needed to understand why fit, healthy people suddenly develop SCAD. Read more under the tab: “Resources” on SCAD and FMD.

SYMPTOMS of SCAD:

Chest pain in young, fit people with no history of or risk factors for heart disease, is often dismissed as anxiety, panic attacks, indigestion, gall stones and other conditions.

SCAD reduces or stops blood supply to the heart muscle.

Symptoms of SCAD include angina (chest pain). This has also been described as pressure, tightness, squeezing, or someone heavy sitting on your chest.

This 46 minute video from the European SCAD Conference provides a great overview of SCAD.

Other symptoms may include:

· shortness of breath

· rapid heartbeat, fluttery feeling

· pain in arms, shoulders, jaw, neck, back or stomach

· excessive sweating

· unusual/extreme exhaustion

· nausea, vomiting

· dizziness/lightheadedness

· fainting/loss of consciousness

· headache

Risk for SCAD:

SCAD is not fully understood and is widely misdiagnosed. SCAD affects mainly women between ages 30-60 years old – who have otherwise little cardiovascular risks. Many post-partum women are also at risk for dissection. SCAD accounts for about 25% of all heart attacks in women under sixty years old.

It wasn’t too long ago when surviving a SCAD was rare. Today, thanks to committed researchers, advances in technology, and growing awareness more and more individuals are not only surviving but thriving. The Americian Heart Association recently released this statement: “High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented” (Hayes et al., 2018).

Fibromuscular dysplasia

Fibromuscular dysplasia (FMD) has been closely linked to SCAD. FMD is a condition that causes narrowing (stenosis) and enlargement (aneurysm) of the medium-sized arteries in your body. Reduced blood flow from narrowed arteries to the organs can affect the function of the organs.

Fibromuscular dysplasia appears most commonly in the arteries leading to the kidneys but can also affect the arteries leading to your brain, heart, abdomen, arms and legs. FMD can cause a number of complications, such as high blood pressure or tears of the artery (arterial dissection), if left untreated. Your health care provider has likely already tested you for FMD - if not, you may want to suggest you are tested as SCAD can limit blood flow to the organ supplied by the injured artery.

While there isn't a cure for FMD, it can be treated effectively. Some people who have don't even have any symptoms. However, you could have some signs or symptoms of the disease, depending on what artery is affected. For instance, if you have FMD in your kidneys, you could have high blood pressure. If you have FMD in your arteries leading to your brain (carotid arteries), you may have unexplained headaches, dizziness and pulsating ringing in your ears (tinnitus). If you have FMD in your arteries leading to your abdomen (mesenteric arteries), you may have abdominal discomfort or pain. If you have FMD in the arteries leading to your arms or legs (peripheral arteries), these limbs may be cold or uncomfortable. Finally, if you have FMD inthe arteries leading to your heart (coronary arteries), you may have chest pain (rarely a heart attack).

When to See Your Doctor

The Mayo Clinic suggests you go see your doctor if:

• you have any sudden changes in your vision, ability to speak, or new weakness in your arms or legs, seek medical attention immediately

• you have any of the other signs or symptoms listed and are concerned about your risk of fibromuscular dysplasia, see your doctor.

  Because FMD can be hereditary, tell your doctor about your family history of the disease, even before you show any symptoms so that he or she can be alert to changes that might suggest you have fibromuscular dysplasia. The pathophysiology of FMD causing SCAD is not completely known - however, it is suggested due to the genetic abnormality, fibrosis of the vasa vasorum (a network of small blood vessels that supply the walls of large blood vessels) leads to coronary vessel wall ischemia and proliferation of certain cells resulting in dissection.

Alerting ER staff to your condition(s) is also very important. You may want to print out an alert card for shared information with your name, condition, medications and other medical history information. The FMDSA (Fibromuscular dysplasia Society of America) provides this pdf. for your use: file:///C:/Users/Owner/Desktop/SCAD_card%20FMD%20ER%20Card3(1).pdf

Life After SCAD

We know that every SCAD survivor and their family has a different experience both of the SCAD event and subsequent recovery. Most of us ask ourselves, “Why me?” Fit and healthy people aren’t supposed to have heart attacks. Often this question is followed by feelings of isolation, frustration, grief, stress, trauma, anxiety, depression and more.

References:

Hayes, S., Kim, E., Saw, J., Adlam, D., Arslanian-Engoren., C. et al. (2018). Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association. 137:e523–e557

Saw J, Aymong E, Mancini GB, Sedlak T, Starovoytov A, Ricci D., Canadian Journal of Cardiology (2014). Nonatherosclerotic coronary artery disease in young women. (7):814-9.

Saw J, Ricci D, Starovoytov A, Fox R, Buller CE. (2013). Spontaneous coronary artery dissection: prevalence of predisposing conditions including fibromuscular dysplasia in a tertiary center cohort. JACC Cardiovascular Intervention. (1):44-52.