by Barbara Curtis
When we're young and healthy, we feel unstoppable. We conquer deadlines, marathons (whether the running or Netflix variety), and juggle growing responsibilities without worry about our health. So when we experience feelings of fatigue, chest pressure or shortness of breath during an especially busy week, we chalk it up to stress.
But for an unlucky few, these symptoms could be the result of a heart attack caused by spontaneous coronary artery dissection (SCAD) -- a rare, but urgent condition that can strike even the seemingly unstoppable.
"SCAD most often presents itself in young, healthy women who are not at risk for heart disease, but can happen to men and women of all ages," says Sharayne Mark Coffin, MD, cardiologist on the medical staff at Chester County Hospital.
SCAD occurs when a tear develops in one of the heart's arteries. This can allow blood to pool and form a blockage, resulting in a heart attack, abnormal heart rhythms or sudden cardiac arrest.
According to the American Heart Association, an overwhelming number of SCAD patients are women. The condition may also be responsible for 35% of heart attacks in women under the age of 50 and for 43% of pregnancy-associated heart attacks. The average age of a SCAD patient ranges from 45 to 53 years old, but occurs in younger and older populations as well.
Spontaneous Coronary Artery Dissection: Signs and Symptoms
Symptoms of SCAD mirror those of a heart attack, including:
- Chest pain
- Rapid heartbeat
- Pain in the arms, shoulders or jaw
- Shortness of breath
- Sweating
- Unusual tiredness
- Nausea
- Dizziness
"Unfortunately, medical providers cannot predict when or if SCAD will occur. Since the condition can progress quickly, it's important to take these symptoms seriously and call 9-1-1, no matter how healthy or fit you may be," Dr. Mark adds.
According to the SCAD Alliance, some patients may experience an abrupt, sharp pain as a result of the dissection of the artery, while others may experience subtle signs, such as fatigue, before feeling symptoms of a heart attack.
Risk Factors
Medical researchers are unsure what causes spontaneous coronary artery dissection, but have found some common risk factors:
- Being a woman
- Pregnancy/giving birth (pregnancy-associated instances of SCAD most often occur in the first four weeks after delivery)
- Fibromuscular dysplasia
- Blood vessel problems, including lupus and polyarteritis nodosa, which cause inflammation of the blood vessels
- Family history of inherited connective tissue disease
- Severe high blood pressure
- Use of illegal substances
- Extreme physical exercise
- Severe emotional stress
Differences in Treatment
Heart attacks are less likely to occur as a result of SCAD but rather atherosclerosis, a slow process where fatty material and cholesterol build-up in the vessel wall of the heart. In these cases, physicians will often use stents to open clogged blood vessels to restore blood flow to the heart. Since SCAD heart attacks are not a result of atherosclerosis, medical providers are more likely to recommend a conservative approach by prescribing medication.
"For a large number of SCAD patients who are in stable condition, the artery will heal on its own. Providers may prescribe medication to assist with pain and cardiac rehabilitation to regain strength," says Dr. Mark.
In high-risk cases, such as prolonged ischemia (reduced blood flow to the heart) or left main artery dissection, physicians may need to open the artery with a balloon or stent to increase blood flow, or perform a surgical bypass to find a new passage for blood to flow to the heart.
"SCAD can also reoccur later in life, so it is important to inform your medical provider if you have a personal or family history of the condition," Dr. Mark adds.
Sharayne Mark Coffin, MD, is a cardiologist at Cardiology Consultants of Philadelphia, Chester County Cardiology Associations Division.
Related Information from Chester County Hospital: