What is SCAD?
Finding Hope in Knowledge
Spontaneous Coronary Artery Dissection (SCAD) is an under-diagnosed cause of acute coronary syndrome (ACS), heart attack and sudden cardiac arrest. When a SCAD occurs there is a separation and a hemorrhage within the layers of a coronary artery wall, which may or may not create a tear and a flap of tissue that blocks blood flow to the artery. SCAD is not associated with atherosclerosis like most “typical” heart attacks. It strikes without warning, traumatizing survivors who are often women younger than 50 years old. The cause of SCAD is currently unknown although some known factors include emotional stress, physical stress, possibly inflammatory disorders and connective tissue diseases. Many doctors are unsure how to treat SCAD, and misdiagnosis or symptom dismissal occurs too often.
Symptoms
Because spontaneous coronary artery dissection reduces or stops blood supply to the heart muscle, symptoms of SCAD include angina (chest pain) without having a heart attack or angina with heart attack.
Chest
Discomfort or pain described as pressure, tightness, squeezing, or elephant on the chest.
Upper Body
Radiating discomfort or pain into the arms, upper back, neck, or jaw.
Lungs
Shortness of breath ranging from trouble taking breaths to a smothering sensation.
Fatigue
Extreme exhaustion, unrelated to activity or sleep quality.
Sweating
Unexplained cold, clammy perspiration.
Nausea
Ranging from indigestion to vomiting
How it Happens
Most SCAD patients experience heart attacks due to blocked arteries from a hematoma, but dissections may occur and not cause a heart attack. Depending on the percentage of blockage by a flap or blood clot, the heart muscle may not be damaged. Instead, the patient experiences what is called acute coronary syndrome (ACS).
If the artery is severely blocked, the heart muscle becomes starved for blood and the muscle tissue begins to die. In this case, the patient is having a heart attack, which can be diagnosed by testing for elevated troponin enzyme levels in the blood and by confirming changes in electrocardiogram (ECG or EKG) readings.
Current research reports that more than 50% of SCADs are “ST Elevation myocardial infarctions,” the type of heart attack resulting in muscle damage. Nearly 25% of SCAD patients have multi-vessel dissections when diagnosed. However, OCT and IVUS are not available in all hospitals.
Unknown and Overlooked
One of the most overlooked evidence of SCAD may be death. It remains unknown how many people die of SCAD each year. Those who suffer cardiac arrest may not be identified as SCAD if the family does not request an autopsy. SCAD Alliance places great emphasis on education and awareness of SCAD in the medical community for this very reason. It is quite possible SCAD is an unrecognized subset of the 600,000 heart attack deaths each year in the U.S.
With increased awareness of SCAD among emergency medical professionals and more readily available Automatic External Defibrillators (AEDs), sudden cardiac arrest from SCAD can be caught in time.
