A Different Kind of Heart Attack

Author: Jennifer Abfalter, MA, APRN, CNS
Co-author: Julibeth Lauren, PhD, APRN, CNS

February is National Heart Month, a time dedicated to raising awareness about heart disease. The Centers for Disease Control warns that heart related conditions continue to be the leading cause of death for both men and women in the U.S. Over 610,000 American lives are lost each year to heart disease.  Health Care is paying close attention to a new type of heart attack, which affects individuals who may not be at a high risk for heart disease.

Spontaneous Coronary Artery Dissection (SCAD) is an increasingly recognized cause of heart attack that affects persons differently than the more familiar heart attack caused by coronary artery disease. SCAD most often affects young healthy women, and may also occur in men, who do not have typical risk factors for heart disease. The average age of a SCAD occurs between approximately 30-60 years old.  SCAD is also a common cause of heart attack in pregnancy, and in the weeks following birth. For younger women, SCAD is no longer a rare diagnosis.

The heart has a system to feed itself, or to provide blood flow to itself called coronary arteries. The difference between these two forms of heart attacks is, in most “traditional” heart attacks there is a gradual buildup of plaque in the coronary arteries, called atherosclerosis. However, SCAD occurs with a sudden and spontaneous tear to the coronary artery. In SCAD, the lining of the coronary artery tears, causing damage to the coronary artery.  When this happens, blood can build up under the tear, or a blood clot can form and block the flow of blood back to the heart.   The SCAD tear can cause chest pain, a heart attack, an abnormal heart rhythm or death.  Heart attack symptoms are an emergency.  The symptoms of SCAD and a traditional heart attack are similar:

  • Chest pain, pressure or burning
  • Pain in the arms, neck or jaw
  • Shortness of breath
  • Nausea
  • Sweating
  • Dizziness
  • Feeling weak or tired
  • A fast or skipping heart beat

What causes SCAD?  For most patients, the cause is not known.  Doctors are studying the possible causes, and more is being discovered every day.  There are some conditions associated with an increased risk of SCAD, these include:

  • Fibromuscular Dysplasia (FMD), a disease that causes blood vessel walls to weaken.
  • Connective tissue disorders, such as Marfan Syndrome.
  • Female, it is estimated that over 90% of cases are in women
  • Pregnancy and women who have just given birth
  • Extreme physical activity
  • Recreational drug use
  • Extreme emotional stress

The treatment for SCAD is under investigation, but sometimes SCAD can heal on its own.  If someone diagnosed with SCAD has damage, which blocks the flow of blood to the heart, they may need to have a procedure to restore blood flow. Treatment depends on each individual’s situation.  There are SCAD specialists in Cardiac Medicine, please see a specialist if you have more questions about SCAD.

Anyone, regardless of age or risk factors should take the symptoms of a heart attack seriously.  Do not wait to see if the symptoms go away.  Seek care right away and be persistent if something does not feel right.  Call your local emergency services (911 in the U.S.).  Do not drive yourself to the hospital.

Elsevier Interactive Patient Education has resources on Chest Pain and how to respond in an emergency.

Learn More:

Contemporary Review on Spontaneous Coronary Artery Dissection from the Journal of the American College of Cardiology

Spontaneous Coronary Artery Dissection (SCAD)

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