Spontaneous Coronary Artery Dissection (SCAD)

Overview

What is spontaneous coronary artery dissection?

The artery wall is made up of thin layers of tissue. In spontaneous (carotid or coronary) artery dissection (SCAD), the layers separate and blood seeps in between the layers. The blood is trapped between the layers, causing a bulge in the wall that blocks the artery. This blocks or partially blocks blood flow to the heart and can cause a heart attack (if it is a total blockage) or chest pain (if it is a partial blockage).

SCAD is a rare condition, and doctors and scientists continue to expand their knowledge about it through research.

Who develops SCAD?

SCAD can occur at any age, but most cases occur in otherwise healthy people between the ages of 30 and 50. SCAD is far more common in women than men. In one study of 440 cases of SCAD that occurred at a single hospital between 1931 and 2008, 98 percent involved women.

What are the risk factors for having SCAD?

Doctors do not know exactly what causes SCAD or if it can be prevented. Although there is still a lot to be learned about SCAD, the following factors appear to increase the risk:

  • Female gender.
  • Pregnancy or giving birth, suggesting SCAD is linked to changes in hormones or blood volume that occur during pregnancy. One-third of all cases of SCAD occur during pregnancy or soon after giving birth.
  • Fibromuscular dysplasia (FMD), a disease that causes abnormal cell development in the artery wall.
  • Extreme exercise.
  • Underlying blood vessel inflammatory disease like lupus.
  • Connective tissue disease like Marfan syndrome.
  • Very high blood pressure.
  • Cocaine use.

Symptoms and Causes

What are the symptoms of SCAD?

For many people the first symptom of SCAD is a heart attack because the dissection has caused a complete blockage in the artery. Even if the coronary artery is not completely blocked, symptoms are the same as heart attack because the heart is not getting enough blood:

  • Chest pain
  • Rapid heart beat
  • Shortness of breath
  • Sweating
  • Unusual tiredness
  • Nausea
  • Dizziness

SCAD is an urgent situation. An individual experiencing chest pain alone or in combination with any of the other symptoms should or call 911.

Management and Treatment

How is SCAD treated?

Treatment for SCAD depends on the symptoms and severity of the disease, ranging from chest pain to heart attack. SCAD is a rare disease, and a heart attack caused by SCAD is not a typical heart attack. For these reasons, it is important that an individual with SCAD be treated by a doctor who is experienced in diagnosing and treating this disease.Treatment may include any of the following or a combination:

  • Letting the dissection heal.
  • Blood thinners (like warfarin) to reduce the risk of blood clots.
  • Other medications like beta-blockers, particularly in individuals who have FMD.
  • Stents.
  • Bypass surgery.

What are the complications of SCAD?

The most serious complication is the possibility of a second dissection. A second dissection has been reported in up to 17 percent of people after the first dissection. People who have FMD have a higher risk for this happening. If the doctor believes the patient has a high risk for another dissection, the patient may be kept in the hospital for several days for observation, but a second dissection could occur months or years later. There is no way to predict this and unfortunately no way to prevent this.

Outlook / Prognosis

What is the outlook (prognosis) for people with SCAD?

Generally, survival is good in individuals who survive the initial event – chest pain or heart attack. SCAD is a rare disease, and there is not a lot of information about it yet. Doctors and scientists do not have enough data to know the long-term outlook and prognosis.

What research is being done on SCAD?

Doctors have much to learn about treatment and prevention of SCAD. The National Institutes of Health is sponsoring studies at several major medical centers to try to determine what causes it. Mayo Clinic is heading up a database/registry of patients with SCAD (whether or not they have been patients at Mayo Clinic). By collecting data on patients with SCAD, researchers can identify patterns of SCAD incidence, causes and associations that could guide future research.

Living With

What type of follow-up is needed after SCAD is diagnosed?

It is very important for individuals with SCAD to be under the care of a doctor who is familiar with the disease and has treated patients with it. A person with SCAD should follow his or her doctor's instructions for regular follow-up visits and medications. The doctor may recommend an annual CTA or MRA to monitor the condition of the coronary arteries.

Resources

Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.

Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart and Vascular Institute Outcomes.

Cleveland Clinic Heart and Vascular Institute Cardiovascular Medicine Specialists

Choosing a doctor to treat your vascular disease depends on where you are in your diagnosis and treatment. The following specialists diagnose and treat patients with SCAD:

To make an appointment, call Cardiovascular Medicine Appointments, toll-free 800.223.2273, extension 46697 or request an appointment online.

Learn more about our FMD and SCAD Clinic

You may also use our MyConsult second opinion consultation using the Internet.

Contact

If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy