SCAD: The Dangerous Heart Attack that’s Striking Healthy Young Women

Jul 20 2017 - 12:12pm
SCAD heart attack

Spontaneous coronary artery dissection — sometimes referred to as SCAD — is an uncommon emergency condition that occurs when a tear forms in one of the blood vessels in the heart. This frightening condition strikes suddenly, without warning, and is most common in young healthy women in their 30’s, 40’s, and 50’s, and you have probably never even heard of it.

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What is SCAD?

SCAD happens when a small tear happens within the walls of the coronary artery. These tears appear to occur naturally, and without predisposing cause or warning. This small tear can allow blood to enter between the layers of the arterial wall, creating a loose flap of tissue on the inside of the artery. Blood that has entered between the layers of the arterial wall can collect and clot, causing a narrowing of the artery and slowing or blocking blood flow. See this video from the Mayo Clinic for animation of SCAD and how it occurs. SCAD may result in angina (chest pain), myocardial infarction (heart attack), heart rhythm abnormalities, or sudden cardiac arrest.

Who is at risk of SCAD?

While SCAD is considered a rare traumatic condition, approximately 80% of all cases affect women. The condition appears to be linked to female hormone levels, as it often occurs in women during the post-partum period, or in women during or very near menstruation, however this is not always the case. It is not uncommon for SCAD to occur in people who are in good physical shape, and with no known prior history of heart disease or pre-existing risk factors. SCAD’s have been known to occur both during exercise and periods of rest. SCAD is an unpredictable event with patients usually experiencing a sudden, unexpected heart attack. It can affect all age groups and is recognized as a cause of heart attacks in young adults. Both sexes can be affected.

What are the symptoms of SCAD?

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Symptoms of SCAD are similar to traditional heart attack symptoms, and include: chest pain; a rapid heartbeat or fluttery feeling in the chest; pain in the arms, shoulders, or jaw; shortness of breath; sweating; unusual, extreme tiredness; nausea; and dizziness. SCAD can cause sudden death if not diagnosed and treated promptly, so if you are experiencing the above symptoms, it is important to call 911 and seek medical attention immediately, even if you don’t think you are at risk for heart attack.

Although SCAD causes a small percentage of heart attacks overall, it is responsible for 40% of all heart attacks in women under the age of 50.

“This is an important cause of heart attacks among younger people, and it has really only been in the past 4 or 5 years that our thinking on it has changed. For the past 100 years, we had been missing it,” says Sharonne N. Hayes, MD, of the Mayo Clinic in Minnesota, one of the world’s most renowned SCAD researchers.

How is SCAD treated?

The treatment of SCAD is focused on repairing the tear to the artery to restore blood flow to the heart. Depending on the location and severity of the tear, treatment options may include any combination of the following: the use of blood-thinning or blood-pressure-regulating medications; placement of a stent to restore blood flow; bypass surgery; and cardiac rehabilitation. Doctors don’t know how to prevent SCAD and often give patients personalized recommendations. But given its high chance of happening again, patients are generally told to take a daily aspirin. They are also asked to avoid getting pregnant, taking hormone therapy, high-intensity or high-impact sports, and heavy lifting that causes strain, like body building or shoveling snow.

Hayes is helping to write the first scientific statement about SCAD for the American Heart Association in the hopes of improving diagnosis rates and standardizing treatment. It’s set to be released later this year.

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