Sometimes, a heart attack is the result of spontaneous tearing in the coronary artery wall.
The artery wall has three layers and when a tear occurs, blood can pass through the innermost layer and become trapped and bulge inward. This narrows or blocks the artery and can cause a heart attack because blood flow can’t reach the heart muscle. When this type of tear happens without warning, it’s called spontaneous coronary artery dissection (SCAD).
Researchers aren’t sure what causes SCAD, but patients are often women who are otherwise healthy, with few or no risk factors for heart disease. Scientists think it’s likely that multiple factors may cause SCAD, such as abnormalities in the arteries, genetics, hormonal influences or inflammatory issues. These may be made worse by stressors in a person’s environment.
Recent studies have also shown many SCAD patients also have fibromuscular dysplasia, a condition that causes abnormal cell growth in the arteries that can cause narrowing, beading or tearing in the artery walls, or aneurysm.
Physical or emotional stress are commonly reported to have happened before SCAD. Emotional stressors have been reported more in women. Physical stressors such as isometric exercise and lifting weights have more often occurred before SCAD in men.
Though SCAD can happen in men and people of nearly any age, it occurs overwhelmingly in women in their 40s and 50s. It may cause acute coronary syndrome in up to 35% of heart attacks in women 50 and under. And though pregnancy-related SCAD makes up a small percentage of all SCAD cases, it’s the most common cause of heart attacks during pregnancy.
Although SCAD can cause a life-threatening heart attack, SCAD patients don’t typically have other heart disease risk factors. That’s why 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 and dizziness.
Treatment for SCAD patients may differ from other heart attack patients, who may require a procedure to insert a stent to hold the artery open or bypass surgery. More conservative therapy that emphasizes blood pressure control and medication can have better results. For patients who are unstable with ongoing signs of a heart attack, stent placement or bypass surgery may be used.
Health care professionals may recognize the signs of SCAD using an angiogram (PDF), but an intravascular ultrasound or optical coherence tomography screening that allows doctors to see the artery from the inside out makes it easier to see. However, those tests are not as readily available as an angiogram.
SCAD patients have a high risk of recurrence and 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, such as high blood pressure, smoking or high cholesterol.
Dr. Naesha Parks began her journey with SCAD in 2008, just ten days after giving birth to her son. Her doctors discovered that she had a coronary artery dissection which required open heart surgery. Here's her amazing story: