Postpartum and postmenopausal people are most at risk for spontaneous coronary artery dissection (SCAD). The inner layer of a coronary artery separates or tears, slowing blood flow to the heart. It can cause acute coronary syndrome, angina (chest pain) or a heart attack. This life-threatening condition requires immediate care.
Spontaneous coronary artery dissection (SCAD) occurs when there’s a separation or tear in the wall of a coronary artery. The tear can occur in any one of the three layers of the coronary artery wall. Blood seeps between the layers. This trapped blood causes the artery to bulge inward. The bulge blocks or slows blood flow to your heart.
SCAD increases your risk of acute coronary syndrome. This is a type of coronary artery disease that causes chest pain or angina. You’re also at risk of having a life-threatening heart attack.
To better understand this condition, it can help to break down the meaning of each term:
Acute coronary syndrome is an umbrella term for conditions that lead to a sudden reduction of blood flow to your heart. It occurs when fatty deposits called plaque unexpectedly rupture inside an artery. This buildup of plaque is also known as atherosclerosis or “hardening of the arteries.” CAD increases your risk of life-threatening heart failure, heart attack or stroke.
Medical experts consider SCAD to be an underdiagnosed condition. It may account for up to 4% of all cases of acute coronary syndrome and 1 in 4 cases in women and people assigned female at birth (AFAB) who are younger than 50.
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Experts aren’t sure why SCAD occurs. Many people who develop this artery tear are younger and physically active. And, they don’t have a known history of heart disease.
People who develop SCAD have recently given birth. SCAD is also more likely to occur around the time of menstruation or during postmenopause. These risk factors suggest that fluctuations in female hormones may play a role.
Men and people assigned male at birth (AMAB) account for less than 10% of SCAD incidents. Arterial tears in men most often occur after strength training or lifting a heavy object. The physical exertion may cause the tear.
In rare instances, the force of severe vomiting or coughing may cause the artery wall to tear. A traumatic accident or a medical procedure like a cardiac catheterization can cause a coronary artery dissection. This type of tear has a known cause.
People with certain conditions may be more prone to coronary artery dissection. These conditions include:
SCAD is a medical emergency. Call 911 if you experience heart attack symptoms, such as:
Spontaneous coronary artery dissection can be challenging to diagnose. If you have chest pain or other signs of a heart attack, your provider may perform these tests to check for a SCAD:
As many as 3 in 4 people who develop SCAD improve with medications, such as those used to:
An estimated 14% of people have severe SCAD that requires urgent, in-hospital treatments, which may include:
If you’ve had an artery tear, you may need to restrict certain physical activities and strength training to prevent another tear. Your healthcare provider may also recommend cardiac rehabilitation. This rehab improves your heart health and teaches you how to exercise safely.
Currently, there’s no known direct link between SCAD and hormonal birth control. But most healthcare providers recommend nonhormonal birth control options first, such as vasectomy and tubal ligation. Ask your healthcare provider which option is right for you.
You can also take heart-protective measures to lower your risk of heart disease. You can:
SCAD can be life-threatening, claiming the lives of up to 5% of people who develop it. An artery tear increases your risk for:
Call 911 if you think you’re having a heart attack. You should call your provider if you experience:
You may want to ask your healthcare provider:
A note from Cleveland Clinic
Spontaneous coronary artery dissection (SCAD) causes heart attack-like symptoms among people who are at low risk for heart problems. Women and people assigned female at birth (AFAB) are most at risk. You should call 911 anytime you experience heart attack symptoms. If tests indicate SCAD, your healthcare provider will discuss treatment options. Even with treatment, you have a higher chance of having another artery tear. Your provider will closely monitor your heart health to lower this risk.
Last reviewed by a Cleveland Clinic medical professional on 08/04/2022.
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