When an older woman has a heart attack, it is almost always the result of coronary artery disease (CAD). But when a young woman has a heart attack, often no evidence of CAD is found. That’s because a common cause of heart attack in young women is spontaneous coronary artery dissection, or SCAD.
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“The typical SCAD patient is a female in her 40s to 50s, though it can occur even younger. Pregnancy can cause SCAD; however, we find no predisposing factor in almost half of patients,” says Cleveland Clinic vascular medicine specialist Esther Kim, MD.
A scientific advisory board member for the SCAD Alliance, Dr. Kim is heavily involved in research into this little-known disease.
A new diagnosis
In SCAD, the lining of a coronary artery rips, allowing blood to seep between the layers. This causes a blockage or a blood clot that produces severe chest pain or a heart attack. In some patients, it causes an electrical malfunction of the heart that results in sudden death. That’s why identifying people at risk for SCAD is so important.
Risk factors for SCAD
In addition to pregnancy, having recently given birth or simply being female, there is evidence linking SCAD to connective tissue disorders, including Ehlers-Danlos syndrome and Marfan Syndrome. Systemic inflammatory conditions such as lupus have also been associated with SCAD.
New findings suggest that 60-80 percent of patients with SCAD may have fibromuscular dysplasia (FMD), another vascular disease that targets young and middle-aged women.
SCAD can also affect extreme athletes, people with very high blood pressure and cocaine users.
So little is known about SCAD that most cardiologists don’t recognize it or know how to treat it. That’s why it’s important to see a specialist who has experience in vascular disease and in diagnosing and treating SCAD if you’ve survived an unexplained heart attack or have one of the risk factors for SCAD.
Medications to protect the arteries from stress are the preferred mode of treatment. “Many of these dissections heal on their own,” says Dr. Kim.
If chest pain does not respond to medications, stenting may be a last resort.
Dr. Kim uses a team approach to evaluate and treat SCAD, involving an exercise physiologist to prescribe a safe exercise program, a psychiatrist to treat anxiety, a rheumatologist to treat any underlying immune disease and a geneticist to help determine if a genetic disorder may have caused the SCAD event. She, herself, looks for FMD and other genetic diseases.
“Often times, SCAD is the result of another disease, but if doctors don’t check for it, it can go undiagnosed and may lead to potentially preventable cardiovascular events,” she says.