Spontaneous Coronary Artery Dissection (SCAD)

Medical Intel from MedStar Washington Hospital Center

SCAD—A Silent Killer of Healthy Young People

What is Spontaneous Coronary Artery Dissection (SCAD)?

Artery walls have three layers. When a tear or dissection occurs blood is able to flow through the inner most layer and become trapped and bulge inward. This narrowing of the artery or blockage can cause a heart attack because blood cannot flow to the heart muscle.

Spontaneous Coronary Artery Dissection or SCAD is an uncommon medical event because it occurs spontaneously in otherwise healthy younger people without prior symptoms.

Who is at risk for SCAD?

SCAD usually occurs in people who do not have the well known cardiovascular risk factors such as high cholesterol, atherosclerosis, high blood pressure and diabetes.

The average age of a SCAD patient is 42 years old, but it can occur in people in their twenties. SCAD is more than twice as common in women as men. SCAD may result from blood vessel changes, hormonal and other changes associated with pregnancy or menopause. Extreme exertion appears to play a role in both men and women.

What are the signs and symptoms of SCAD?

The signs and symptoms vary widely with some people reporting the classic heart attack symptoms of an “elephant sitting on my chest” to just mild discomfort. Many women still think that heart disease affects only men, but more than half of the 500,000 Americans who die each year of a heart attack are women. Women’s heart attack symptoms can be more subtle than men’s; so many women brush them off as insignificant because they don’t see themselves at risk. Women are more likely to experience the following:

  • Chest discomfort or fullness
  • Blackouts or fainting
  • Shortness of breath during activities or upon waking up
  • Chronic fatigue that interrupts routine activities
  • Dizziness
  • Swelling (especially the lower legs and ankles)
  • Rapid heartbeats that may cause pain or difficulty breathing
  • Nausea or vomiting that’s unrelated to diet, indigestion or abdominal pain
  • Sweating
  • Impending feeling of doom

If you experience any of these symptoms frequently (about once a day), don’t wait, call 911 immediately. Minutes count during a heart attack. Time is muscle. These symptoms are serious and should not be ignored.

How is SCAD diagnosed and treated?

Cardiac angiography or cardiac catheterization is the primary means of diagnosing SCAD. While this diagnostic test can identify the narrowing or blockage of the artery, it does not allow visualization of the vessel walls. Other imaging modalities such as intravascular ultrasound, optical coherence tomography and CT angiography may be ordered to assist your physicians in making the definitive diagnosis.

Treatment options vary by the type and severity of the SCAD event. Some patients respond favorably to conservative treatment using medication only. Certain drugs such aspirin, Coumadin, nitroglycerin, beta blockers and ACE inhibitors will be likely be given and some drugs may be prescribed for life. Some patients may undergo cardiac angioplasty and receive a stent or coronary artery bypass surgery.

For more information, or to schedule an appointment, call

202-759-0267

As heard on WTOP Radio:

Susan K. Bennett, MD

Pictured: Susan K. Bennett, MD,
Cardiovascular Disease

To find a cardiac specialist, please call 202-759-0267

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