Spontaneous Coronary Artery Dissection – Diagnosis and Treatment

ByJanis Updated

Diagnosis

Spontaneous coronary artery dissection (SCAD) is often discovered during emergency hospital visits when patients report chest pain or symptoms similar to acute coronary syndrome.

Health care providers usually start by reviewing the person’s health background, including family risk factors, and quickly move to testing.

Common Tests for SCAD

A variety of tests help identify SCAD and related heart problems:

Test Name Purpose Details & What It Detects
Electrocardiogram (ECG/EKG) Checks electrical signals in the heart. Helps find abnormal rhythms, T-wave inversion, or signs of myocardial injury.
Blood tests (Troponin, Cardiac Biomarkers) Measures levels of certain proteins. Elevated troponin indicates heart muscle damage.
Coronary Angiography Visualizes heart arteries using dye and X-ray. Detects dissection in arteries and twisted vessels.
Optical Coherence Tomography (OCT) Uses light to scan inside blood vessel walls. Reveals the extent and location of artery tearing.
Intravascular Ultrasound (IVUS) Applies sound waves inside arteries. Produces detailed images of artery structure.
Echocardiography Uses ultrasound from outside the chest. Measures ejection fraction and systolic function.
Cardiac CT Angiography (CCTA) Non-invasive 3D images of heart vessels. Can show narrowed areas or blockages.

Electrocardiogram (ECG)

Clinicians place small adhesive pads, called electrodes, on the chest, arms, and legs. The ECG displays patterns that may reveal current or past heart attacks and changes such as T-wave inversion.

Blood Tests

Laboratories analyze samples to reveal raised troponin and other cardiac biomarkers, which indicate myocardial injury.

Imaging Techniques

Clinicians consider coronary angiography the main test for confirming SCAD. They insert a thin tube (catheter), usually through the groin or wrist, to reach the heart.

A special dye highlights the coronary arteries, allowing doctors to see dissections, blockages, and the often-affected left anterior descending artery. During angiography, clinicians may also perform additional procedures like OCT or IVUS.

OCT provides very detailed images using light, while IVUS uses sound waves to create pictures from inside the artery. Both help confirm the diagnosis if initial results are unclear.

Echocardiography and Coronary Computed Tomography Angiography

Clinicians use echocardiography to check heart pumping ability and ejection fraction, which shows how much the heart has been affected.

CCTA offers a non-invasive look at the arteries and may help in some cases where other tests aren’t available or are less clear.

Treatment

Medications for SCAD Management

Most people with spontaneous coronary artery dissection (SCAD) receive medications to manage their symptoms and help prevent more artery problems.

These drugs can include:

  • Antiplatelet Agents: Often recommended for daily use, aspirin can lower the risk of heart complications by thinning the blood and preventing clots.
  • Beta-Blockers: These medications help manage blood pressure and reduce the risk of another SCAD episode.
  • Calcium Channel Blockers and Nitrates: Used to relieve chest pain by relaxing the blood vessels and improving blood flow.
  • Other Blood Pressure Medicines: Individuals may receive other types of medicines for lifelong blood pressure control, reducing strain on the arteries.

The specific combination of medicines depends on a person’s symptoms, risk factors, and other health issues. Medications play a key role, but sometimes clinicians recommend further intervention if symptoms do not improve.

Procedures and Surgical Options

If medicine is not enough, clinicians may perform certain procedures or surgeries to restore good blood flow to the heart.

These include:

  • Coronary Angioplasty and Stent Placement (PCI):
    • A clinician guides a thin tube called a catheter through a blood vessel to the problem spot in the coronary artery.
    • The balloon at the tip is inflated to open the artery, and a tiny mesh tube called a stent is placed to keep the vessel open.
    • This procedure is often chosen if the artery is severely blocked or if chest pain does not go away with medicine.
  • Coronary Artery Bypass Surgery (CABG):
    • For people who have more than one tear or whose arteries are too damaged for stents, surgeons may recommend bypass surgery.
    • In this operation, a healthy blood vessel—often from the chest wall, such as the left internal mammary artery (LIMA), or from the leg—is grafted to create a new path for blood to reach the heart.
    • This surgery is generally reserved for complex cases or when other treatments have not worked.

Clinicians select these treatments carefully, focusing on the patient’s unique situation and health condition. The goal is always to restore proper blood supply and reduce future risks.

Considerations for Patients Planning Pregnancy

Anyone who has had SCAD should speak with their healthcare provider if they are thinking about having a baby.

Because pregnancy involves major changes in the body and blood vessels, it may increase the risk of another artery problem. Careful planning and medical advice are needed to weigh the risks and use the safest approach.

Cardiac Recovery Programs

After treatment for SCAD, ongoing care supports heart health and recovery. Many patients join a cardiac rehabilitation program, which usually includes:

  • Structured exercise, monitored by professionals.
  • Education about heart-healthy eating and lifestyle choices.
  • Support for mental and emotional health.

This approach helps people return to their normal activities while carefully monitoring their heart.

Daily Habits and At-Home Care

Adjusting daily routines can support heart health and help with conservative treatment for spontaneous coronary artery dissection (SCAD). A mix of healthy choices, regular monitoring, and stress reduction can make a meaningful difference.

Healthy Choices for the Heart

  • No Smoking: Avoid tobacco use and stay clear of secondhand smoke. Stopping smoking may lower the risk of new heart problems.
  • Balanced Diet: Eat plenty of whole grains, fruits, vegetables, and lean protein like fish and beans. Limit foods high in unhealthy fats, added sugars, and sodium.
  • Stay Active: Physical activity helps keep blood pressure, cholesterol, and blood sugar at healthy levels. Gentle exercise, with a doctor’s approval, is often encouraged. People with SCAD should avoid heavy lifting, contact sports, and strenuous activities unless cleared by their provider.
  • Healthy Weight: Aiming for a stable, healthy weight takes stress off the heart and lowers the risk for related conditions.

Alcohol, Sleep, and Regular Checks

Practice Recommendation
Limit Alcohol Women: 1 drink/day; Men: up to 2 drinks/day, if consumed at all.
Blood Pressure Check Test as often as the care team suggests.
Cholesterol & Sugar Regular monitoring if advised.
Sleep 7–9 hours each night, same schedule every day.

Getting enough restful sleep is also important. A steady sleep routine helps reduce the risk of heart problems.

Managing Stress and Emotional Wellbeing

Chronic stress may negatively affect the heart. Stress management could include regular light exercise, mindfulness techniques, or joining a support group.

Key Tips for Lifestyle Modification

  • Follow provider guidance. Always ask your care team before starting a workout or making big diet changes.
  • Monitor health numbers. Keep track of blood pressure, cholesterol, and blood sugar results.
  • Seek help early. Report unusual symptoms or signs to a health professional.

By applying these routines, individuals can better manage their condition and support their recovery at home.

Ways to Handle and Find Help

Adjusting after a SCAD event can be hard. People may feel scared, sad, or frustrated, especially if they face heart failure, ventricular arrhythmia, or have a connective tissue disorder.

Understanding what happened and talking openly with a care team helps many feel more at ease.

Helpful tips include:

  • Learn About SCAD: Knowing about artery tears, treatments, and what to expect reduces anxiety.
  • Seek Support: Joining a support group, either in person or online, can connect people with others who understand their challenges.
  • Talk About Worries: Emotional stress, depression, or fear are normal, especially postpartum or during recovery.

Getting Ready for Your Medical Visit

Spontaneous coronary artery dissection (SCAD) often occurs during emergencies, so some people may not have time to get ready ahead of time.

If someone experiences chest pain or believes they may be having a heart attack, they should call 911 or their local emergency number right away.

After a doctor diagnoses SCAD, preparing for follow-up appointments can be helpful. Making a list of questions can help make the most of the time with the healthcare provider.

Some important questions to consider include:

  • What is the reason for the SCAD?
  • What types of tests will I need?
  • What treatments are available, and which is best?
  • Will the artery heal without intervention?
  • What are the chances of SCAD happening again?
  • Is there another blood vessel problem such as fibromuscular dysplasia (FMD)?
  • How can other health issues be managed together?
  • Are there any foods or activities to avoid?
  • Is pregnancy safe after SCAD?

Patients should ask any other questions they have. Being prepared helps ensure all concerns are addressed.


Related Questions

Responses are AI-generated

Health Writer

Janis's areas of expertise include nutrition, exercise, stress management, and mental health. She is passionate about educating and empowering people to take control of their health and make positive changes that can last a lifetime. Janis believes that small, sustainable changes are the key to long-term success, and she works with her clients to develop personalized plans that fit their individual needs and lifestyles.