Spontaneous Coronary Artery Dissection – Symptoms and Causes

Overview

Spontaneous coronary artery dissection (SCAD) is a serious heart condition. It happens when a tear forms in one of the arteries that supply blood to the heart.

This tear creates a split between layers of the artery wall, which can slow or block blood flow to the heart muscle.

SCAD often strikes without warning. It primarily affects women in their 40s and 50s, though it can occur at any age and occasionally affects men as well.

Many people who experience SCAD don’t have typical heart disease risk factors like high blood pressure, elevated cholesterol, or diabetes.

When SCAD occurs, the tear allows blood to flow between the layers of the artery wall. This can lead to two dangerous situations:

• A flap of tissue may hang into the artery, blocking blood flow
• Blood collecting between the layers can form a clot (intramural hematoma)

Both scenarios can narrow or block the artery, preventing oxygen-rich blood from reaching parts of the heart muscle.

SCAD is considered a medical emergency. Without prompt treatment, it can cause a heart attack, dangerous heart rhythm problems, or even sudden death.

Signs and Symptoms

SCAD might cause several warning signs. These include:

• Chest pain
• Shortness of breath
• Rapid heartbeat
• Pain in arms, shoulders, or jaw
• Extreme fatigue

Pain or pressure in the chest area may feel like pain that spreads to your arms, shoulders, back, or jaw.

Some people notice they cannot breathe easily. Unusual sweating often occurs. You might feel extremely tired without reason. Stomach discomfort can happen too.

A fluttery feeling in your chest or rapid heartbeat might develop. Feeling dizzy is another common symptom.

When To Get Medical Help

Call 911 right away if you have chest pain or think you might be having a heart attack. If emergency services aren’t available, have someone else drive you to the nearest hospital.

Never drive yourself unless you have absolutely no other option. Heart symptoms need immediate medical attention, as quick treatment can save lives.

Causes

The exact reason behind spontaneous coronary artery dissection remains unclear to medical experts. Doctors and researchers have not yet identified a definite cause for this condition.

When it happens, the artery wall tears without an obvious trigger. This medical mystery continues to puzzle healthcare professionals who study heart conditions.

Risk Factors

Several factors may increase your chance of developing SCAD:

• Gender Differences: Women face a higher risk of SCAD than men.
• Pregnancy and Childbirth: The first few weeks after giving birth present an elevated risk, likely due to hormonal changes and blood vessel stress. SCAD can also occur during pregnancy.
• Stress Situations: Both physical and emotional stress can trigger SCAD, including:
  • Intense exercise
  • Severe emotional distress
• Blood Vessel Conditions: Fibromuscular dysplasia (FMD) weakens medium-sized arteries and occurs more frequently in women. This condition can lead to artery problems including dissection.
• Connective Tissue Disorders: People with certain genetic conditions have an increased risk:
  • Ehlers-Danlos Syndrome
  • Marfan Syndrome
• Blood Pressure Issues: Severely high blood pressure raises SCAD risk.
• Substance Use: Cocaine and other illegal drugs may increase the likelihood of developing SCAD.

Complications

SCAD can lead to several serious health issues. The most common complication is a heart attack. This occurs when SCAD restricts or completely blocks blood flow in an artery.

This differs from typical heart attacks caused by atherosclerosis (buildup of fats and cholesterol in arteries).

Some patients experience arterial layer separation. This is where the inner and outer walls of the artery split apart. Blood can collect between these separated layers, creating pressure that worsens the condition.

Risk of Recurrence

SCAD can happen more than once in the same person. Recurrences may occur shortly after the first episode or years later in some cases.

Long-Term Complications:

• Higher risk of future heart problems
• Heart failure due to damage from SCAD-related heart attacks

The damage to heart muscle during a SCAD event can weaken the heart permanently. This affects its ability to pump blood effectively throughout the body.