Definition

Spontaneous Coronary Artery Dissection (SCAD) is an under-diagnosed cause of acute coronary syndrome (ACS), heart attack and sudden cardiac arrest. The inner lining of the coronary artery splits and allows blood to seep into the adjacent layer, forming a blockage (hematoma) or continues to tear, creating a flap of tissue that blocks blood flow in the artery. It strikes without warning, traumatizing survivors. The cause of SCAD is currently unknown. Most doctors are unsure how to treat it.

Q&A about SCAD…

In this webchat, SCAD Alliance scientific advisory board member, Esther Kim, MD, addresses the top concerns of survivors and caregivers: Cleveland Clinic HealthHub

Here’s what we know:

SCAD happens to fairly young, active and otherwise healthy people, although the true impact is unknown due to delayed and mistaken diagnoses.

  • The warning signs of SCAD are the symptoms of a heart attack:  chest pain or pressure, shortness of breath, arm pain, profuse sweating and dizziness.
  • Immediate emergency care for these symptoms is critical.
  • SCAD is not caused by atherosclerosis or plaque rupture. It has no known controllable risk factors.
  • For survivors, treatment ranges from surgery to drug therapy depending on the individual case.
  • Contributing factors to SCAD may include vascular, connective tissue, and genetic conditions.
  • Twenty percent of all female SCAD patients have recently given birth.
  • SCAD can strike again, in the same or different artery, at any time from days to years apart.

The average age of SCAD survivors is 42. Nearly 80% percent of known SCAD patients are women, with 20 percent experiencing their dissection in the peripartum period, either late in pregnancy or in the weeks after having a baby. The remaining women appear to experience SCAD related to extreme exertion or associated conditions such as fibromuscular dysplasia (FMD) or connective tissue disorders, such as Marfan or Ehlers Danlos syndrome (Type IV). Hormone fluctuations also may play a role.

SCAD in men appears to be triggered by extreme physical exertion (e.g., fitness boot camps, triathlons) or the associated conditions as well. SCAD patients overall have none of the typical risk factors associated with other causes of heart attack, such as high blood pressure or plaque rupture from cholesterol build up.

In addition to identifying SCAD’s associated conditions, early research has uncovered facts that prove the urgent need for targeted research and educating the medical community to take a closer look at younger patients exhibiting heart attack symptoms. Contrary to popular belief, SCAD survivors can experience additional dissections, ranging from days to a decade after the original event. Most subsequent SCADs occur in a different vessel. Second or third SCADs have been seen in arteries other than the coronaries, including the femoral and internal carotid arteries. The recurrence rate of SCAD is estimated to be 21%.

SCAD may occur when a combination of factors and conditions occur as a “perfect storm.” Associated conditions of SCAD such as vascular irregularity, hormonal influences, collagen/genetic defect (e.g., Marfan, Ehlers Danlos, other connective tissue disorder), and physical exertion may interact or be subsets of each other.