Coronary artery dissection (SCAD): types, symptoms, treatment

A coronary artery dissection is a serious heart condition that requires emergency treatment. This condition occurs when one of the heart’s arteries develops a tear in its inner lining – one of the three walls of the artery.

One type of coronary artery dissection is called spontaneous coronary artery dissection (SCAD). It happens when the tearing of the inner wall causes blood to pool between the layers. This can cause a blood clot to form, blocking blood flow to the heart muscle. The blood clot can also grow as platelets and other substances build up.

This type of dissection sometimes occurs in the aorta, the large artery that carries blood from the heart to most of the body. When this is the case, the condition is called an aortic dissection.

SCAD occurs more often in women over 50 or postmenopausal, according to a 2015 review. But it’s also a common cause of heart attack in women before menopause. Research from 2014 suggests that aortic dissection is more common in men in their 60s and 60s. But both conditions can develop in anyone at any age.

Read on to learn more about SCAD symptoms, types, causes, and treatments.

Symptoms of aortic dissection and SCAD are similar to signs of a heart attack and include:

  • chest pain
  • shortness of breath
  • pain in one or both arms
  • pain in the shoulders, neck, or jaw
  • cold sweat
  • nausea
  • dizziness

Sudden, severe chest pain and shortness of breath should always be treated as medical emergencies, even if other symptoms are not present or seem as severe.

When to Seek Emergency Medical Help

If you think you or a loved one is having a heart attack, call 911 or local emergency services immediately.

The pain associated with an aortic dissection, as opposed to SCAD or a heart attack, can feel like something is tearing or splitting inside your chest.

In contrast, the pain of a heart attack is often described as a feeling of pressure, heaviness, or constriction.

Symptoms of aortic dissection may also resemble those of a stroke more than a heart attack, such as:

  • weakness or numbness on one side of the body
  • difficulty speaking or understanding speech
  • eyesight problems
  • dizziness, near fainting or fainting

These are the usual symptom patterns for these conditions, but there may be variations. Because there is a significant overlap of symptoms between SCAD, aortic dissection, and heart attack, symptoms alone cannot diagnose them.

Each of these conditions is life-threatening and requires immediate medical attention. At the hospital, doctors will be able to perform a physical exam and run tests to determine the root cause of your symptoms.

It is not always clear why SCAD or other types of arterial dissections occur, although there are known risk factors.

For example, a 2021 study found that women are much more likely than men to develop SCAD. Most women who suffer from SCAD are between the ages of 40 and 50, but people who are pregnant or have recently given birth are also at higher risk for SCAD.

Men are more likely than women to have an aortic dissection.

A study 2019 notes that the following conditions increase the risk of both SCAD and coronary artery dissection:

Other risk factors for SCAD and other types of arterial dissections include poorly controlled high blood pressure, atherosclerosis, and other vascular conditions.

Strenuous exercise, particularly weight lifting, has also been identified as a risk factor for SCAD and aortic dissection.

SCAD is often first diagnosed when a person has a heart attack. The first steps in diagnosing a heart attack include:

  • an electrocardiogram (ECG) to monitor your heart’s electrical patterns and rhythms
  • a blood test to measure troponin, a protein that is released into your blood after a heart attack

SCAD is present in approximately 1 in 4 heart attacks in women under the age of 60. A person with heart attack symptoms may be evaluated for atherosclerosis, a narrowing and stiffening of the arteries. According to American Heart Associationif no atherosclerosis is detected, a doctor should perform a SCAD test.

Coronary angiography is the primary diagnostic method for SCAD. In this invasive test, a thin plastic tube called a catheter is placed inside your artery. Through this catheter, a special dye is injected into the bloodstream that can only be detected by X-rays. A coronary angiogram can detect blood flow problems and can often show the location of the dissection and its severity.

According to a 2014 study, intravascular ultrasound (IVUS) is often used alongside coronary angiography to confirm a diagnosis of SCAD. This type of imaging can help assess the exact location and extent of a tear in the artery.

IVUS is a catheter-based procedure which occurs under a light sedative. A small tube with an ultrasound probe at the end is inserted into the heart and guided by your doctor. This probe sends signals to a computer, creating cross-sectional images. These images provide a real-time 360 ​​degree view of the area of ​​the heart being imaged. IVUS is frequently used to guide placement of a stent to treat blocked arteries.

Doctors can also diagnose an aortic dissection using one or more of the following imaging tests:

If a doctor determines that your aortic dissection is mild and no immediate intervention is needed, they may prescribe certain medications to lower your blood pressure and slow your heart rate.

Medications to treat mild SCAD also include blood pressure medications and blood thinners to reduce the risk of a blood clot forming at the tear site.

If medication isn’t enough to treat the condition, you may need surgery or a catheter-based procedure to treat the injured artery.

For SCAD, open-heart surgery may be performed to bypass the damaged artery with a blood vessel from elsewhere in the body.

An aortic dissection can be repaired surgically. If the heart’s aortic valve is also damaged, a replacement valve may need to be inserted.

In addition to medical therapy and invasive procedures, the Heart and Stroke Foundation of Canada says managing a coronary artery dissection, or SCAD, often means engaging in certain heart-healthy behaviors.

Some important lifestyle changes include:

  • exercising regularly as approved by a doctor
  • avoiding heavy weight lifting and contact sports
  • maintain a moderate weight
  • following a heart-healthy diet, such as the Mediterranean diet
  • manage your blood pressure with medication if needed
  • cut down or quit smoking, if you smoke
  • reduce stress
  • attend cardiac rehabilitation

A 2017 study indicates that a doctor may recommend taking beta-blockers with some of these lifestyle changes. Also, see a cardiologist regularly to monitor your heart health.

Healthy arteries are essential for ensuring proper blood flow throughout the body.

If a coronary artery tears, the heart muscle can suffer due to a reduction in oxygen-rich blood. If the aorta tears, the consequences can be fatal without surgery.

But SCAD and aortic dissection can often be treated if you get immediate medical help. After that, follow a doctor’s advice about medications and lifestyle changes to prevent further heart complications.