What is SCAD?

Spontaneous Coronary Artery Dissection (SCAD) is a little known and poorly understood type of a heart attack caused when a sudden tear occurs within the layers of one or more coronary arteries. This tear partially or completely blocks blood flow to the heart and causes a heart attack. SCAD may also lead to cardiac arrest and sometimes death. Unlike a “traditional” heart attack caused by blockage due to plaque buildup over a lifetime, SCAD is a completely distinct and different artery blockage. SCAD patients typically have minimal or no risk factors for atherosclerosis. SCAD can recur.

SCAD is the #1 cause of heart attacks among women under the age of 50 as well as the #1 cause of heart attacks in pregnant women and new mothers. Most individuals with SCAD are YOUNG, HEALTHY, ACTIVE women who have NO FAMILY HISTORY OF HEART DISEASE. The average age is only 42. Although less common, SCAD can affect MEN too.

This video, from MAYO CLINIC, MEDICAL edge, shows an animation of a dissection.

Spontaneous Coronary Artery Dissection (SCAD) was first described by H.C. Pretty in 1931 when his case study titled “Dissecting aneurysm of a coronary artery in a woman aged 42” was published in The British Medical Journal. His findings were the result of a post mortem examination performed on a woman he attended the previous day for severe stomach vomiting. In her right coronary artery, Pretty found “marked atheroma, with dissecting aneurysm, which had evidently ruptured during the last sudden and violent retching attack.”

Some classify SCAD as an “orphan” condition, and as such, it has received less attention and has been less well studied than other types of heart attack. In 2009, several survivors approached Dr. Sharonne Hayes about conducting research on SCAD. The Mayo Clinic SCAD Research Program (Rochester, MN) was created in 2010 in response to data collection and a research agenda initiated by SCAD survivors through social networking..

Mayo Clinic SCAD Research Program under Dr. Hayes’ leadership has discovered SCAD is far more common than previously thought. While other SCAD research studies have recently started in other institutions, Mayo Clinic’s study population is the largest known SCAD registry in the world.

For more in-depth information, take a look at our Notes from the Research Team.

The exact cause of Spontaneous Coronary Artery Dissection (SCAD) is unknown, but it is probably a combination of factors. Up to 80% of individuals who experience SCAD are women.

Spontaneous Coronary Artery Dissection (SCAD) usually occurs in people who do not have traditional cardiovascular risk factors for build-up of plaque in the arteries (atherosclerosis) such as high cholesterol, high blood pressure and diabetes. Researchers have identified several diseases and conditions as being associated with SCAD, but many time SCAD occur in people with no known risk factors or underlying condition.

The suspected associated conditions or potential triggers for SCAD include:

• • Pregnancy or postpartum period
  • Fibromuscular dysplasia (FMD)
  • Extreme physical exertion
  • Extreme emotional stress
  • Connective-tissue abnormalities and monogenetic mutations
    • Vascular Ehlers-Danlos syndrome (type IV)
    • Marfan syndrome
    • Loeys-Dietz syndrome
    • Autosomal dominant polycystic kidney disease
    • Pseudoxanthoma elasticum

While most individuals who experience SCAD are women, SCAD can occur in men too. Mayo Clinic SCAD research team has observed sex differences in the cause and outcomes of SCAD and more males who have experienced SCAD are needed for research. Through research, more is being learned about SCAD every day.

Because the causes of Spontaneous Coronary Artery Dissection (SCAD) are unknown at this point, there is no scientifically validated way to reduce the risk of SCAD occurring. To help keep your heart healthy, follow advice regarding coronary artery disease prevention in general. In other words, exercise regularly, eat a healthful diet, eliminate risk factors such as smoking and excessive alcohol, and control your blood pressure and stress level. As with all heart health, “know your numbers” and discuss the best options for you with your health care professional.

Symptoms vary widely in Spontaneous Coronary Artery Dissection (SCAD) cases, with some reporting mild discomfort to others experiencing “classic heart attack symptoms.” If you’re experiencing symptoms including chest pain, shortness of breath or other signs of a heart attack, you need emergency diagnosis and treatment. If you think you are having a heart attack, call for help immediately.

Signs and symptoms of a heart attack include*:

• Chest pain, pressure or burning
• Pain in the arms, shoulders or jaw
• Shortness of breath
• Nausea
• Sweating
• Unusual , extreme tiredness
• Dizziness
• A rapid heartbeat or fluttering in the chest *

Many women have heart attack symptoms without chest pain including different symptoms than listed above. Click for additional information about heart attacks in women, elderly and diabetics.

SCAD is known to occur both during exercise and at rest.

* Heart attack signs and symptoms listed are from Mayo Clinic Patient Education Spontaneous Coronary Artery Dissection (SCAD) materials.

Since Spontaneous Coronary Artery Dissection (SCAD) is a type of heart attack, patients typically have medical tests that are consistent with a heart attack diagnosis, including abnormal electrocardiogram (ECG) and elevated levels of cardiac enzyme blood tests (most commonly troponin). A diagnosis of SCAD is made by its typical appearance at the time of a coronary angiogram (heart catheterization) or occasionally by a CT scan of the heart. In case of sudden death, an autopsy may reveal SCAD.

Advances in medical technology and awareness have led to more individuals surviving. Survival for a SCAD heart attack is now better than a “regular” heart attack.

One of the biggest challenges in diagnosing SCAD is getting health care professionals to see past the young, seemingly healthy individual before them and take steps to determine the correct diagnosis. Even the patients themselves and family members may not suspect a young, healthy person could be experiencing a cardiac event such as a heart attack.

Sadly, like many with heart disease, some SCAD patients have initially been sent away from the ER with a diagnosis of a panic attack or a gastric problem only to return with more severe symptoms – this delay can be fatal.

Read more about tests and diagnostic procedures here.

Although much has been learned about Spontaneous Coronary Artery Dissection (SCAD) in the past few years, there is still no known cause and no way to prevent SCAD. However the accurate differentiation of SCAD is crucial because the approach to acute and long term care is different. Specifically, patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) due to SCAD have technical success rates that are markedly reduced compared to PCI success rates for atherosclerosis ACS (62% vs. 92%).

Research has identified several associated conditions and shown that patients with acute SCAD should be treated differently from other heart attack patients. Diagnosing and treating SCAD is more complex than traditional heart attacks. Conservative, non-invasive treatment is often best.

Research has noted a substantial rate of spontaneous vascular healing and suggests a role for conservative management in stable SCAD patients who have preserved coronary flow. Conservative management includes 4-5 days of careful inpatient monitoring. If there is a complete artery blockage or the patient is unstable or having chest pains, an invasive procedure to treat SCAD such as stents or bypass surgery may be recommended.

Statins do not appear to prevent another SCAD heart attack and one study found more recurrence in those taking statins.

Physicians may recommend medication such as aspirin, blood pressure medication and medication to treat chest pain.

SCAD can recur, so vigilance, evaluation of associated conditions, and staying up-to-date on emerging research is also important.

Click For additional information on research findings,

Following hospital discharge, enrolling in a cardiac rehabilitation program is a very important step in the recovery process – both physically and emotionally. Cardiac rehab nurses are well equipped to advise regarding diet and exercise. Cardiac rehab sessions help to rebuild confidence after what can be an extremely frightening experience.

A good diet, plenty of rest, stress reduction, realizing your limitations, help and support from loved ones, listening to your body, and a carefully controlled exercise program are all key factors for healing and recovery. Seek advice from your health care professional to develop a comprehensive plan.

Spontaneous Coronary Artery Dissection (SCAD) is an emergency which requires urgent treatment While SCAD is sometimes fatal, advances in medical technology and awareness have led to more individuals surviving. Survival for a SCAD heart attack is now better than a “regular” heart attack. You are more likely to recover your heart function than after a heart attack caused by atherosclerosis.

Research is key to determining the cause and identifying a way to prevent SCAD.

The time for a dissected artery, or arteries, to heal will vary from person to person. Some case studies in the medical literature report spontaneous healing within the first few days, often noted on a follow-up angiography. There is growing belief, however, that in Spontaneous Coronary Artery Dissection (SCAD) patients should only undergo repeat angiography in emergency circumstances due to the risk of worsening the dissection, disrupting the healing process, or causing a new dissection during the procedure.

It is not uncommon for a SCAD patient to experience ongoing chest pain or other symptoms. Sometimes this may be related to stenting or bypass grafting. Some SCAD patients develop scar tissue in the artery related to stents. For those being treated with medication and monitoring, it may be helpful for their cardiologist to adjust their dosages. Other patients are left with varying degrees of heart failure as a result of damaged heart muscle.

Be sure to talk to your health care professional if you are worried about ongoing symptoms.

First, take comfort that you are not alone. Breathe! A common saying of heart disease patients is finding their “new normal” which means you have to re-learn what is now normal for your body to feel. Many SCAD patients describe feeling frightened by every sensation, questioning whether another SCAD is about to happen. They experience a loss of confidence in their body, which takes time to return. Some of the medications, and combinations of medications that SCAD patients are prescribed can have side effects, and it may be hard to know whether a symptom is caused by medications, the original dissection, the resulting cardiac event, or from the treatments of stents or surgery or a new/recurrent SCAD. Not all medications are right for every patient, and you may have to work with your doctor to get the right combination and dosages that work best for you.

The following methods may help you to find and adjust to your “new normal”:

• Find a doctor you like. You may not find a local doctor experienced in caring for SCAD patients but it is important to find a doctor who will do more than tell you how “rare” or “unique” you are!
• Participate in research. The Mayo Clinic studies are open to patients globally. Take a look at the Research section for more information.
• Exercise. Talk to your doctor and cardiac rehabilitation nurses about an appropriate exercise plan.
• Engage in enjoyable activities. Life doesn’t have to stop after a SCAD event but the adjustments vary from person to person. Listen to your body.
• Reduce stress. Stress is not a direct risk factor for cardiovascular disease but it may contribute to your risk level. Many SCAD patients describe experiencing extreme stress prior to their SCAD events.
• Connect with others. Don’t let yourself become isolated; pick up the phone, send an email, write a letter, join a group! Above all, don’t wait for family and friends to call first. To find an online or in-person support community, see the Support & Additional Info section.
• Seek counseling to supplement medical treatment. The emotional toll of a heart attack can be so severe that those who survive the experience may develop post-traumatic stress disorder (PTSD), a condition that doubles the risk of experiencing additional severe heart disease.
• Learn all you can about SCAD and the medications you take. Knowledge is power, and continuous learning keeps you empowered, informed and in control.
• Ask your doctors any questions you may have and be your own advocate!

Spontaneous Coronary Artery Dissection (SCAD) can recur, so vigilance, evaluation of associated conditions and staying up-to-date on emerging research is also important. Statins do not appear to prevent another SCAD heart attack and one study found more recurrence in those taking statins.

For those who do experience another SCAD, the time between SCAD events varies greatly in the known case studies from a few days to years apart. Usually if SCAD does recur a different artery is affected. Get emergency care if you have symptoms of a heart attack.

While the SCAD Research Program at Mayo Clinic has identified familial cases of in Spontaneous Coronary Artery Dissection (SCAD), occurrence of SCAD in more than one family member appears to be very rare, accounting for only ~1-2% of total cases in the Mayo Clinic registry. Assuming you do not have a family history of connective tissue disease, e.g. Marfan or Ehlers-Danlos syndrome, or aortic aneurysm/dissection, the chances of a family member having SCAD are very low. Preliminary investigation into the genetics of SCAD has ruled out a common disease gene, however ongoing research enabled by SCAD Research, Inc continues to explore the DNA sequence in search of changes that confer susceptibility to SCAD.