Spontaneous Coronary Artery Dissection (SCAD)

What is spontaneous coronary artery dissection (SCAD)?

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.

What does the term “spontaneous coronary artery dissection” mean?

To better understand this condition, it can help to break down the meaning of each term:

• Spontaneous means the condition happens without warning.
• Coronary arteries are cardiac blood vessels that carry oxygen-rich blood to your heart. You have a left and right main coronary artery that branch into smaller blood vessels.
• Dissection is the medical term for the separation of tissue.

What is acute coronary syndrome?

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.

How common is spontaneous coronary artery dissection (SCAD)?

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.

What causes spontaneous coronary artery dissection (SCAD)?

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.

Who is at risk for spontaneous coronary artery dissection (SCAD)?

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).
• Hypothyroidism.
• Inflammatory diseases like lupus, multiple sclerosis (MS) and sarcoidosis.
• Substance use disorder.

What are the symptoms of spontaneous coronary artery dissection (SCAD)?

Lack of blood flow from SCAD can cause a heart attack or a type of chest pain called unstable angina. This dangerous form of angina increases your risk of heart attack.

SCAD is a medical emergency. Call 911 if you experience heart attack symptoms, such as:

• Dizziness or fainting (syncope).
• Excessive sweating (hyperhidrosis) or clamminess.
• Heart palpitations or arrhythmia.
• Musculoskeletal pain in your arm, shoulder or jaw.
• Nausea and vomiting or indigestion.
• Shortness of breath.

How is spontaneous coronary artery dissection (SCAD) diagnosed?

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:

• Enzyme marker test to check for elevated levels of cardiac enzymes that can indicate a heart attack.
• Angiogram to view moving 3D images of blood flow to your heart. This may include coronary computed tomography angiogram (CCTA) or magnetic resonance angiogram (MRA).
• Intravascular optical coherence tomography (IVOCT) to view the artery from the inside out.
• Intravascular ultrasound (IVUS) to capture detailed images of the inside of your arteries.

How do providers treat spontaneous coronary artery dissection (SCAD)?

As many as 3 in 4 people who develop SCAD improve with medications, such as those used to:

• Manage blood pressure (beta blockers).
• Manage high cholesterol.
• Prevent blood clots (antiplatelet medications).

An estimated 14% of people have severe SCAD that requires urgent, in-hospital treatments, which may include:

• Cardiac catheterization and coronary angioplasty and stent (interventional procedures).
• Coronary artery bypass grafting (CABG).
• Left ventricular assist device (mechanical circulatory support) or implantable cardioverter defibrillator (ICD).
• Heart transplant (extremely rare).

Can you prevent spontaneous coronary artery dissection (SCAD)?

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:

• Consume a heart-healthy diet to lower cholesterol levels.
• Cut back on sodium and manage high blood pressure.
• Drink alcohol in moderation and get help for alcohol use disorder.
• Know your fats and eat less unhealthy fats.
• Manage diabetes.
• Seek help to quit smoking.
• Stay physically active and maintain a healthy weight.

What is the outlook for someone with spontaneous coronary artery dissection (SCAD)?

SCAD can be life-threatening, claiming the lives of up to 5% of people who develop it. An artery tear increases your risk for:

• Chronic angina: A small number of people develop this ongoing chest pain or pressure. It doesn’t respond well to traditional treatments like nitroglycerin.
• Disease recurrence: About 1 in 10 people have a recurrence of SCAD within three years of the initial treatment. Your healthcare provider may order more frequent tests to detect tears sooner.
• Heart inflammation: SCAD can contribute to pericarditis, inflammation of the sac that covers your heart. Your provider may order cardiac MRIs or angiograms to check for this problem.

When should I call the doctor?

Call 911 if you think you’re having a heart attack. You should call your provider if you experience:

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

What should I ask my provider?

You may want to ask your healthcare provider:

• What caused the spontaneous coronary artery dissection?
• Can I get spontaneous coronary artery dissection again?
• What steps should I take to protect my heart health?
• Should I look for signs of complications?

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.