What are the other Names for this Condition? (Also known as/Synonyms)

• Idiopathic SCAD
• Idiopathic Spontaneous Coronary Artery Dissection
• SCAD (Spontaneous Coronary Artery Dissection)

What is Spontaneous Coronary Artery Dissection? (Definition/Background Information)

• Spontaneous Coronary Artery Dissection (SCAD) is a rare and acute condition in which the coronary artery develops a tear on its wall. The coronary arteries are critical blood vessels that supply blood to the heart. SCAD is a medical emergency that needs to be treated promptly
• Due to pressure of the blood being pumped from the heart, a small tear can become large and cause the blood to flow along the walls or in between the layers of the arterial walls. This can result in insufficient blood flow to the heart muscles
• Many young and middle-aged women with no prior history of heart disease are known to develop Spontaneous Coronary Artery Dissection. The risk factors for the condition may include advancing age, intense physical activity, vascular conditions such as systemic lupus erythematosus, certain connective tissue disorders, etc.
• The signs and symptoms of Spontaneous Coronary Artery Dissection may include chest pain, pain that radiates along the jaw and shoulder (like in heart attack), sweating, nausea, and feeling extremely tired
• The diagnosis of Spontaneous Coronary Artery Dissection may involve a complete physical examination, assessment of symptoms, blood tests, heart-related tests, and imaging studies. In case of non-specific symptoms, it may be difficult to diagnose SCAD
• Treatment of Spontaneous Coronary Artery Dissection may be undertaken using medications, when the symptoms are not very significant, or through surgical interventions, which may involve a coronary artery bypass graft surgery
• Since, it is an emergency medical condition, a prompt diagnosis and speedy treatment helps improve the prognosis. The prognosis of Spontaneous Coronary Artery Dissection also depends upon its severity and overall health of the individual

Who gets Spontaneous Coronary Artery Dissection? (Age and Sex Distribution)

• Spontaneous Coronary Artery Dissection is an uncommon condition that may be observed in adults (average age around 40 years)
• Both males and females are at risk, but a vast majority of cases are reported in women in the 30-50 years’ age group with no previous history of heart disease
• All racial and ethnic groups may be affected and no particular preference is noted

SCAD may remain undiagnosed due to a set of non-specific symptoms in many, and hence, the exact prevalence of the condition among the general population is unknown.

What are the Risk Factors for Spontaneous Coronary Artery Dissection? (Predisposing Factors)

In many individuals, no risk factors for Spontaneous Coronary Artery Dissection are noted. However, in some cases, the following risk factors may be observed:

• Advancing age that reduces the strength and elastic properties of the coronary arteries. Also, fibromuscular dysplasia (FMD), a condition that weakens the walls of the arteries can increase the risk
• Young and middle-age women seem to have a higher risk for SCAD
• SCAD has been occasionally reported in women who have recently given birth (usually reported within the first few weeks after delivery)
• Intense physical activity is an important risk factor
• Episodes of severe emotional stress
• Congenital conditions that involve or affect the coronary artery, such as Marfan syndrome, Ehlers-Danlos syndrome, Turner syndrome, polycystic kidney disease (adult), connective tissue disorders, and osteogenesis imperfecta
• Chest trauma, such as caused by the impact of any direct force, during an accident
• Hypertension or elevated blood pressure that remains untreated
• Coronary artery disease
• High cholesterol levels in blood
• Use of cocaine
• Being affected by a kind of syphilitic infection, where the arterial walls become inflamed and tender, termed syphilitic aortitis
• Having had a heart surgery, such as for heart valve replacement, a bypass surgery, etc.
• If the individual already has an aortic aneurysm (bulge in the artery due to a localized wall weakness)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Spontaneous Coronary Artery Dissection? (Etiology)

The walls of the coronary artery are made of several layers that are fine, strong, and elastic in nature. When a separation of these layers take place due to blood infiltration, the layers tear or split, leading to a condition called Spontaneous Coronary Artery Dissection (SCAD). In some cases, a balloon-like bulge may appear on the walls, called coronary artery aneurysm, filled with blood.

Some of the factors that are known to influence the development of SCAD include:

• An advancing age, which considerably reduces the resilience and elasticity of the aorta. This may be present with other factors, such as high blood pressure, connective tissue disorders, valvular conditions, and a family history of dissection
• Congenital problems of the heart
• Accidental injury to the chest
• Syphilitic aortitis
• Pregnancy, mostly in women with underlying conditions, such as Marfan syndrome
• Sometimes, performing certain cardiologic (surgical) procedures may result in trauma to the region

In some young women, Spontaneous Coronary Artery Dissection occurs without any prior cause (Idiopathic SCAD).

What are the Signs and Symptoms of Spontaneous Coronary Artery Dissection?

Individuals with Spontaneous Coronary Artery Dissection may have mild to severe chest pain (such that it may be mistaken for a heart attack). Sometimes, no pain is felt, even though a tear of the arterial wall has taken place. The symptoms may vary form one individual to another.

The signs and symptoms of Spontaneous Coronary Artery Dissection may include:

• The location of the chest pain may indicate the exact location/origin of the dissection
• The pain can sometimes feel like an indigestion or a heartburn
• Discomfort may be felt in the upper body region; the pain may extend to the neck and jaw area
• Severe tearing pain at the shoulder, extending down to the armpits and back
• Shortness of breath; sensation of heart beating rapidly
• Difficulty swallowing due to pressure on the esophagus
• Nausea and vomiting
• Stress and anxiety - fearing a heart attack due to chest pain, or having heart-attack like symptoms (heavy sweating, pale skin, breathing trouble when lying on bed)
• Reduced or increased pulse rate
• Feeling faint and dizzy
• Fatigue and tiredness
• Rarely, severe vomiting and/or severe constipation may be noted, which can increase the stress on the body

How is Spontaneous Coronary Artery Dissection Diagnosed?

A Spontaneous Coronary Artery Dissection may be diagnosed based on the presenting signs and symptoms, medical and family history, and other diagnostic test results.

The physical evaluation may include:

• Using a stethoscope to listen to any abnormal sounds from the heart or lungs; a heart murmur may be heard
• Noting the blood pressure difference between the two arms or legs; noting high or low blood pressures
• Indications or presence of signs, similar to a heart attack
• Observing for any signs of shock, even though the blood pressure may be normal

The following tests and exams may also be used to aid in diagnosing SCAD:

• Electrocardiogram (EKG) to record the electrical activity of the heart
• Blood tests: Blood tests, such as troponin test, CK-MB test, and serum myoglobin analysis, are used to measure elevated amounts of certain proteins in the bloodstream
• Coronary angiography: This test is often performed during a heart attack using a dye and special X-rays, to see the insides of the coronary arteries and detect any blockages
• Stress test of the heart: Medical studies may be performed to determine blood flow in the coronary arteries of the heart. This assessment of blood flow can either be performed using a treadmill exercise test, or using a pharmacologic stress test of the heart
• MRI and CT scan of chest
• X-ray of the chest
• Transesophageal echocardiogram
• Using a Doppler ultrasound to check the blood flow pattern in the body

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Spontaneous Coronary Artery Dissection?

Complications due to Spontaneous Coronary Artery Dissection may include:

• Complete rupture of the coronary artery
• Cardiac tamponade (pressure build-up on the heart muscles due to fluid accumulation)
• Myocardial ischemia (reduced blood flow to the heart)
• Pulmonary edema (fluid in the lungs, causing breathing difficulties)
• Heart attack: Some studies have shown that about 1 in 25 heart attacks may be caused by SCAD
• Recurrence of signs and symptoms of SCAD
• Shock and reduced blood pressure due to coronary artery aneurysm and/or aneurysmal rupture, leading to fatal conditions
• Aortic insufficiency or regurgitation (where backward flow of blood into the heart occurs)
• Complications due to invasive procedures used to treat SCAD

An accompanying complication that arises is due to the loss of blood flow to some of the major organs (and parts of the body), such as to the brain, liver, kidneys, and the damage this causes. These can manifest in numerous life-threatening ways and is contingent upon the part affected (and the duration for which it occurs).

How is Spontaneous Coronary Artery Dissection Treated?

Quick, early diagnosis and appropriate, urgent treatment is the key to averting life-threatening complications of Spontaneous Coronary Artery Dissection from developing, since SCAD is a medical emergency. The treatment depends on the severity of the condition. However, in individuals with stable SCAD without any significant symptoms, the treatment may be using medication alone.

The treatment of Spontaneous Coronary Artery Dissection may involve:

• Beta-blockers to reduce high blood pressures and stress; the drugs may be administered to lower blood pressure
• Intense pain is controlled using pain-killers (usually morphine)
• Fibrinolysis (mechanism to prevent clot formation) with clot-busting medications
• Oxygen therapy, using higher concentration levels of oxygen, may be required in some individuals
• Percutaneous coronary intervention (PCI), to place stent at the site of artery blockage
• Surgery, such as coronary artery bypass grafting, may also be used to treat SCAD, in many individuals who require surgical interventions to address the condition
• Open surgery: This is the most standard form of surgery, where the condition is managed by surgically operating on the chest
• Undertaking the treatment of any underlying condition or disorder that may increase an individual’s risk for SCAD

A periodic and long-term follow-up with one’s heart specialist is recommended following treatment for Spontaneous Coronary Artery Dissection.

How can Spontaneous Coronary Artery Dissection be Prevented?

Spontaneous Coronary Artery Dissection is a serious condition that may be prevented in some cases. In some women, with no case history of heart disease, it may not be possible to prevent SCAD. In such cases, an early recognition of the condition and prompt treatment may be beneficial.

The following preventative measures may be considered:

• Maintaining a healthy lifestyle and optimum body weight, which includes ‘no smoking’ (or consumption of other tobacco-based products), keeping blood pressure under check, staying physically fit, with reduced stress, etc.
• Avoiding intense physical exercises and work-outs
• Be careful while driving (always wear a seat belt), while performing any physical tasks/job-related activities, or while exercising with weights. These factors may place you at increased risk for a potential traumatic chest injury
• Have regular consultations with your family physician, more so, if there is a family history of an aortic aneurysm or a heart-related condition
• Use of stool softeners, in case of constipation, if needed
• Undertaking early diagnosis and treatment of any associated condition
• Managing stress

What is the Prognosis of Spontaneous Coronary Artery Dissection? (Outcomes/Resolutions)

• Spontaneous Coronary Artery Dissection is a critical heart condition requiring emergency medical treatment. With timely, aggressive, and active treatment administration, the condition can be managed effectively
• Following SCAD, it is advised that individuals undergo regular medical checkups with diagnostic testing to periodically monitor functioning of the heart and blood circulatory systems
• If SCAD is left untreated or diagnosed late, it can potentially lead to death

Additional and Relevant Useful Information for Spontaneous Coronary Artery Dissection:

Patient education and periodic screening/checkups for heart conditions are encouraged, particularly for individuals who have crossed the age of 40 years.