Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is when a coronary artery wall separates or tears without warning. The tear can occur in any one of the three layers of the coronary artery wall. Blood seeps between the layers, which trap it. This makes the artery bulge inward. The bulge blocks or slows blood flow to your heart. This reduces how much blood gets to your heart, which can cause chest pain.

SCAD increases your risk of (and can cause) acute coronary syndrome. This term includes conditions that lead to a sudden drop in blood flow to your heart.

Medical experts aren’t sure how many people have this condition. They think there are people who have coronary artery dissection but don’t have a diagnosis. Some cases are too subtle for tests to detect. SCAD may account for up to 4% of all cases of acute coronary syndrome.

Symptoms of spontaneous coronary artery dissection

SCAD symptoms are like those of a heart attack. The most common symptom is chest pain or pressure. Other symptoms include:

• Dizziness or fainting
• Excessive sweating or clamminess
• Heart palpitations
• Pain in your arm, shoulder or jaw
• Nausea and vomiting
• Shortness of breath

Coronary artery dissection is an emergency. It can lead to a heart attack. Call 911 if you experience these symptoms.

SCAD causes

Experts aren’t sure why spontaneous coronary artery dissection occurs. It’s different from a plaque rupture and traditional atherosclerotic disease. Many people who develop this artery tear don’t have risk factors for heart disease.

Possible stressors or triggers may include:

• Physical stress, like strength training
• Emotional stress
• Pregnancy or delivery
• Severe physical trauma
• Severe vomiting or coughing (rare)

Risk factors

Most people who have a spontaneous coronary artery dissection are females in their 40s and 50s. Males account for fewer than 1 out of 10 cases.

People with certain conditions may be more prone to coronary artery dissection. These conditions include:

• Connective tissue diseases like Marfan syndrome
• Dangerously high blood pressure
• Fibromuscular dysplasia (FMD)
• Inflammatory diseases like lupus and sarcoidosis
• Substance use disorder

Following these steps may lower your risks:

• Seek help to quit smoking.
• Stay physically active.
• Maintain a weight that’s healthy for you.

Complications of this condition

A lack of blood flow from spontaneous coronary artery dissection can cause a heart attack. When your heart isn’t getting enough blood because of SCAD, it can’t pump enough blood to your body, either (heart failure). This can lead to cardiogenic shock.

When your heart muscles can’t get enough blood, they can’t beat properly. This can lead to an abnormal heart rhythm and sudden cardiac death.

How doctors diagnose this condition

If you have chest pain or other signs of a heart attack, your provider may use these tests to make a SCAD diagnosis:

• Electrocardiogram (EKG) to record your heart’s electrical activity
• Coronary angiogram to show blood flow in your heart arteries using dye and X-rays (this is the main test to diagnose SCAD)
• Enzyme marker test to check for high levels of heart enzymes that can mean a heart attack
• Optical coherence tomography (OCT) to view the artery
• Intravascular ultrasound (IVUS) to get detailed images of the inside of your arteries

How do you treat spontaneous coronary artery dissection?

Spontaneous coronary artery dissection treatment may include medicine or procedures.

SCAD treatment includes medicines like:

• Aspirin to prevent blood clots
• Beta-blockers to keep spontaneous artery dissection from coming back
• Calcium channel blockers, if you have chest pain after SCAD

Most SCADs heal without intervention. But a little more than 1 out of 10 people with this condition need better blood flow. They need urgent care in a hospital for this. These treatments may include:

• Angioplasty and stenting (in selective and high-risk cases)
• Coronary artery bypass grafting (rare)
• Implantable cardioverter defibrillator (or ICD, in certain cases)
• Left ventricular assist device (or LVAD, in very bad cases)

Recovery time

Because of the risk of another SCAD or heart attack, you may be in the hospital for three to five days. With treatment, a tear heals in most people in several weeks. Recovery is longer if you have a procedure.

When should I see my healthcare provider?

Call 911 or your local emergency service number if you think you’re having a heart attack. You should call your provider if you have:

• Chest pain or pressure (angina)
• Cold sweats
• Pain in your arms, jaws or shoulders
• Shortness of breath
• Unexplained fatigue, dizziness or weakness

After a coronary artery dissection, you’ll need regular follow-ups with a heart specialist. This may include imaging tests.

You may want to ask your healthcare provider:

• What caused the spontaneous coronary artery dissection?
• What steps should I take to protect my heart health?
• Should I look for signs of complications?
• Do I need vascular imaging?

What to expect after a SCAD

Most people with SCAD improve with medicines and have a good prognosis (outlook).

But spontaneous coronary artery dissection increases your risk of:

• Chronic angina: A small number of people develop this ongoing chest pain or pressure.
• Recurrence: This condition can happen again. Your healthcare provider may order more frequent tests to detect tears sooner.

If you’ve had an artery tear, you may need to restrict certain physical activities to prevent another. Also, your healthcare provider may recommend cardiac rehab. This improves your heart health and teaches you how to move safely.

People rarely die from a spontaneous artery dissection.