A torn blood vessel in the heart can cause a heart attack. Learn about the diagnosis and treatment of this medical emergency.
Spontaneous coronary artery dissection — sometimes referred to as SCAD — is an emergency condition that occurs when a tear forms in a blood vessel in the heart.
SCAD can slow or block blood flow to the heart, causing a heart attack, heart rhythm problems (arrythmias) or sudden death.
SCAD most commonly affects women in their 40s and 50s, though it can occur at any age and can occur in men. People who have SCAD often don't have risk factors for heart disease, such as high blood pressure, high cholesterol or diabetes.
SCAD can cause sudden death if it isn't diagnosed and treated promptly. Seek emergency attention if you have heart attack symptoms — even if you think you aren't at risk of a heart attack.
Signs and symptoms of SCAD can include:
If you have chest pain or think you might be having a heart attack, call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only as a last resort.
The cause of spontaneous coronary artery dissection is unknown.
Risk factors for SCAD include:
Some episodes of SCAD have occurred after extreme or intense physical exercise and severe emotional stress.
SCAD is a tear inside an artery that carries blood to the heart. When the inner layers of the artery separate from the outer layers, blood can pool in between the layers. The pressure of the pooling blood can make a short tear longer. Blood trapped between the layers can form a blood clot.
SCAD can slow blood flow through the artery, which weakens the heart muscle. Or blood flow through the artery can stop, causing heart muscle to die (heart attack). A heart attack as a result of SCAD is different from a heart attack caused by hardening of the arteries (atherosclerosis).
SCAD can happen more than once, despite successful treatment, either soon after the first episode or years later. People who have SCAD can also have a higher risk of other heart problems, such as heart failure due to the damage to the heart muscle from heart attacks.
Tests used to diagnose SCAD, which are similar to those used to evaluate other types of heart attacks, can include:
During a coronary angiogram, a health care provider injects a special dye into the arteries so they'll show up on imaging tests. To get the dye into the arteries, the provider inserts a long, thin tube (catheter) into an artery — usually in the arm or leg — and threads the tube to the arteries in the heart.
Once the dye is released, X-rays are used to create pictures of the arteries. The X-rays can show problems in an artery, which can help confirm SCAD. A coronary angiogram can also show if the arteries in the heart are twisted (tortuous arteries).
An intravascular ultrasound test might be done in addition to coronary angiography to help health care providers confirm SCAD and plan treatment. During heart catheterization, a special imaging catheter is passed into the arteries to create pictures using sound waves.
A catheter equipped with a special light is passed into the arteries to create light-based pictures. This test may be done after coronary angiography.
The optical coherence images can show problems in an artery that can help health care providers confirm a diagnosis of SCAD and gather information to guide treatment.
During cardiac CT angiography, you usually lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest, which may reveal problems in your arteries.
Cardiac CT angiography might be used with other tests or as a follow-up test to evaluate your condition after SCAD.
The goal of treatment for SCAD is to restore blood flow to the heart, manage chest pain and prevent recurrence. Sometimes, this healing will occur naturally. Or doctors might have to restore blood flow by opening the artery with a balloon or stent. Bypass surgery also might be used.
The treatments most appropriate for you will depend on your condition, including the size and location of the tear in the artery, as well as your signs or symptoms. Whenever possible, health care providers allow the damaged artery to heal on its own.
For some people, medications might relieve the symptoms of SCAD, so it might be possible to be treated with medications alone. If chest pain or other symptoms persist, other treatments might be needed.
If SCAD has blocked blood flow to your heart or if medications don't control your chest pain, your health care provider might recommend placing a tiny mesh tube (stent) inside your artery to hold it open. A stent can help restore blood flow to your heart.
To position the stent, the health care provider inserts a long, thin tube (catheter) into an artery — usually in your leg or arm — and guides the tube to the arteries in your heart. X-rays help the health care provider see where to place the catheter.
A wire with a deflated balloon is passed through the catheter to the tear in the artery. The balloon is then inflated, expanding the stent against your artery walls. The stent is left in place to hold the artery open.
If other treatments haven't worked or if you have more than one tear in an artery, your health care provider might recommend surgery to create a way for blood to reach your heart.
Coronary bypass surgery involves removing a blood vessel from another part of your body, such as your leg. That blood vessel is stitched into place so that it diverts blood flow around your damaged artery.
After SCAD, your health care provider might recommend medications, including:
After treatment for SCAD, you'll need regular follow-up appointments with your health care provider to monitor for changes in your condition. Your provider is likely to recommend cardiac rehabilitation.
Cardiac rehabilitation is a customized program of exercise and education that is designed to help you recover from a serious heart condition. The program often includes monitored exercise, nutritional counseling and emotional support.
SCAD can be an unexpected and shocking diagnosis. The condition can cause serious and concerning symptoms, and it often affects people who have few risk factors for heart disease.
To manage the condition, you might try:
Learning more about your diagnosis. Learn about SCAD to feel comfortable talking with your health care provider about your care. Ask about the specifics of your situation, such as the location and size of your artery tear and descriptions of the treatments you've received and where you can find more information.
Women who have had SCAD might be advised to avoid pregnancy.
Take care of yourself. Get enough sleep, eat a healthy diet full of fruits and vegetables, and find ways to manage stress, such as listening to music or keeping a journal.
If you feel anxious or depressed, talk to your health care provider. He or she might recommend that you talk to a mental health professional.
In most cases, SCAD is an emergency situation. If you have chest pain or think that you're having a heart attack, immediately call 911 or your local emergency number.
After your initial diagnosis, you're likely to have questions about your situation. Prepare a list of questions to ask your health care provider at your next visit. Questions you might want to ask include:
Don't hesitate to ask other questions you have.
November 19th, 2021