Coronary Artery Dissection: Not Just a Heart Attack

A heart attack can happen with sudden tearing in the coronary artery wall.

The artery wall has three layers. With a tear, blood can pass through the innermost layer. The blood can get trapped and swell inward. This narrows or blocks the artery and can cause a heart attack. When this tear happens without warning, it’s called spontaneous coronary artery dissection, or SCAD.

Researchers aren’t sure what causes SCAD. Patients are usually postpartum or postmenopausal women who are otherwise healthy. They usually have few or no risk factors for heart disease. Other risk factors for SCAD are having dangerously high blood pressure and substance use disorders. Scientists think that multiple factors may cause SCAD, such as:

• Abnormalities in the arteries
• Genetics
• Hormonal influences
• Inflammatory issues

These may be made worse by stressors in a person’s environment.

Studies have shown many SCAD patients also have fibromuscular dysplasia. This is a condition that causes abnormal cell growth in the arteries. It can cause narrowing, beading or tearing in the artery walls, or aneurysm.

Physical or emotional stress are often reported to have happened before SCAD. Emotional stressors have been reported more in women. Physical stressors have more often occurred before SCAD in men.

SCAD can happen in men and people of nearly any age. But it does happen most in women in their 40s and 50s. Pregnancy-related SCAD is a small percentage of all SCAD cases. It’s also the most common cause of heart attacks during pregnancy.

SCAD can cause a life-threatening heart attack. Still, SCAD patients don’t typically have other heart disease risk factors. Recognizing the symptoms of a heart attack is crucial for SCAD patients. Warning signs may include:

• Chest pain or pressure
• Shortness of breath
• Profuse sweating
• Dizziness

Treatment for SCAD patients may differ from other heart attack patients. Typical heart attack patients may need a stent to hold the artery open or bypass surgery. SCAD treatment may be more conservative with blood pressure control and medication to lower cholesterol. SCAD patients who are unstable with ongoing signs of a heart attack may need stent placement or bypass surgery.

Health care professionals may spot the signs of SCAD using:

• Enzyme markers
• Angiogram (PDF)
• Intravascular ultrasound
• Optical coherence tomography, which shows the artery from the inside out

People who have a SCAD are at high risk of another. They should let their health care team know about changes to their health. They should also make sure they’re reducing other risks for heart disease by:

• Staying physically active
• Reaching a healthy weight
• Following a heart healthy-diet
• Reducing their sodium intake
• Limiting their alcohol intake
• Quitting smoking
• Managing other conditions such as diabetes, high blood pressure  or high cholesterol. 

Dr. Naesha Parks began her journey with SCAD 10 days after giving birth to her son. Her doctors discovered a coronary artery dissection that needed open-heart surgery. Here's her amazing story: