Heart & Stroke Conditions Explained

Definition

Spontaneous Coronary Artery Dissection (SCAD)

The coronary arteries come from the aorta and spread out over the surface of your heart like the branches of a tree, supplying your heart with oxygen and nutrients. The walls of the arteries are made up of 3 layers (an inner, middle and outer layer)

SCAD is an uncommon emergency condition in which a ‘tear’ happens within the layers of the wall of the artery. This leads to blood becoming trapped within the artery, forming a clot and causing a partial or complete blockage. This can lead to a possible heart attack, an abnormal heart rhythm or even sudden death, if not treated promptly.

Symptoms

Spontaneous Coronary Artery Dissection (SCAD)

The symptoms are very similar to those of angina or a heart attack, these include;

  • Chest pain, tightness or pressure radiating to arms, neck, back or stomach
  • Shortness of breath
  • Profuse sweating, nausea, lightheaded or dizziness

Causes and Prevention

Spontaneous Coronary Artery Dissection (SCAD)

Researchers are not fully sure what causes SCAD, but it is known that 80% of sufferers are women and 30% of those are nearing the end of a pregnancy or have recently given birth.

Most people with SCAD are otherwise healthy and might not have any risk factors for heart disease. It tends to occur in people between the ages of 19 to 64 years.

Other possible causes include:

  • Fibromuscular dysplasia  (the abnormal development or growth of cells in the walls of the body’s arteries)
  • Inherited connective tissue disorders, eg, Marfans Syndrome  and vascular Ehlers-Danlos Syndrome.
  • Extreme physical exertion or severe emotional stress may also increase the risk for SCAD.
  • Severely high or untreated high blood pressure can be associated with SCAD.
  • Cocaine or other illegal drug use may also increase the risk.

Unfortunately, unlike coronary heart disease, it doesn’t seem to be preventable and happens out of the blue.

Diagnosis

Spontaneous Coronary Artery Dissection (SCAD)

SCAD is a difficult condition to diagnose because it doesn’t have any warning signs prior to causing angina or a heart attack.

Coronary angiography may recognise the signs of SCAD, however, intravascular ultrasound or specialised screening is necessary for a definitive diagnosis.

Treatment

Spontaneous Coronary Artery Dissection (SCAD)

The aim of treatment in SCAD is to restore blood flow to the heart muscle.

The most appropriate treatment will depend on the severity of the tear, its location, and of course your signs and symptoms.

If possible, allowing the tear to heal naturally, without any invasive procedures is ideal. Management using medications alone that can control blood pressure is often preferred. In some people, coronary stenting can also be used to restore blood flow to the heart. In some cases, bypass surgery may be necessary. However, the risk of complications is higher and the success rate lower.

Cardiac Rehabilitation

Cardiac rehab is a very important part of SCAD recovery, especially if you were fit and well prior to the cardiac event. Loss of confidence is very common, and so exercising in a safe, controlled environment, is highly beneficial.

Risk of Recurrence

SCAD can recur, usually in a different coronary artery, so it is important to be aware of any signs or symptoms and act promptly. Lifestyle modifications to reduce pressure on the heart and coronary arteries should be adhered to.

Resources

Spontaneous Coronary Artery Dissection (SCAD)

Angioplasty and Angiogram – our guides from symptoms to treatment

Step by Step through Heart Attack – our patient information booklet

Angina – our guide from symptoms to treatment

Step by Step through Heart Medicines – our patient information booklet

Heart & Stroke Conditions A-Z – see our range of guides.

Your Heart Health – view our articles on ways to manage and reduce your risk factors, from being active to stresscholesterol, losing weightblood pressure and more.

Events

Spontaneous Coronary Artery Dissection (SCAD)

Patient meeting on Spontaneous Coronary Artery Dissection

SCAD is a rare potentially fatal condition predominately affecting young women.

The Irish Heart Foundation is to host a special meeting next month for people who have experienced Spontaneous Coronary Artery Dissection (SCAD), a rare potentially fatal cardiac condition predominately affecting young women.

The meeting for people living with the effects of SCAD takes place on Saturday 09 March from 12pm to 4pm at the Irish Heart Foundation offices in Rathmines, Dublin 6.

SCAD is caused by a sudden tear in the layers of the wall of an artery supplying the heart. Blood then gets trapped in these layers, forming a clot and causing a partial or complete blockage. This can lead to a sudden heart attack, an abnormal heart rhythm or even sudden death, if not treated quickly.

Most people with SCAD have no other risk factors for heart disease such as high blood pressure, high cholesterol or a history of smoking making it a particularly devastating event.

The Irish Heart Foundation’s SCAD event will hear from Pauline O Shea, a SCAD survivor who will speak about her experience of SCAD and her vision to develop a SCAD support group in Ireland. It will also be addressed by Dr Caitriona Canning, Consultant Vascular Surgeon, St James’s Hospital in Dublin who has a special interest in SCAD and Dr Angie Brown, Consultant Cardiologist and Medical Director of the Irish Heart Foundation.

The meeting also aims to give people affected by the condition the opportunity to meet face to face and share their experiences, update attendees on the latest medical developments in SCAD and to explore the possibility of developing a SCAD support group in Ireland.  To this end, Karen Rockell, BeatSCAD UK and Lucinda McNerney, who runs the Irish Heart Foundation’s Long QT syndrome support group will also address the event and share their experiences of establishing a support group.

SCAD usually strikes between the ages of 19 and 64 but mainly affects young people. More than 80 per cent of those affected by SCAD are women and 30 per cent are in late pregnancy or have recently given birth. SCAD is one of the most common causes of heart attack in pregnancy or the post-partum period. The condition Fibromuscular dysplasia (FMD); a rare condition which causes abnormal growth in the walls of the arteries, has also been linked with SCAD.

For more information or to register to attend this event please contact Tracy Egan email: tegan@irishheart.ie

Symptoms