SCAD, which stands for spontaneous coronary artery dissection, is a rare and life-threatening condition in which there is a tear of the coronary artery wall. SCAD can lead to abnormal heart rhythms, heart attack, or cardiac arrest.
If SCAD is diagnosed quickly and treated properly, most people will have a full recovery. Patients will need regular follow-up appointments with their cardiologist to monitor their condition.
In about 10% of patients, SCAD reoccurs. In rare cases, it may occur multiple times. These recurrences are more likely to occur within the first few months of the first event, and the risk goes down over time.
After SCAD, patients are generally encouraged to join a cardiac rehabilitation program after leaving the hospital. A SCAD-specific rehabilitation program is recommended when available, which involves:
- Exercise rehabilitation
- To reduce stress on the arteries, the target exercise heart rate is recommended at 50 to 70 percent of heart rate reserve
- Systolic blood pressure (the top number) during exercise is limited to less than 130 mmHg
- Exercise is adjusted so people have a perceived exertion of “moderate” to “somewhat difficult”
- Females should avoid lifting weights greater than 20 to 30 pounds, and males should avoid lifting more than 50 pounds
- Moderate aerobic activity is usually safe, but patients should avoid:
- High intensity training or sports
- Heavy lifting
- Activities that maintain the neck in an extended position for a prolonged period of time, such as certain yoga positions
- Psychosocial counseling
- Dietary and cardiovascular disease education
- Peer group support
What Are Symptoms of SCAD?
SCAD (spontaneous coronary artery dissection) occurs suddenly and without warning and symptoms may resemble a heart attack, including:
- Chest pain
- Heaviness or tightness in chest
- Pain or discomfort in arms, neck, jaw, back, or stomach
- Fast heartbeat or fluttery feeling in chest
- Shortness of breath
- Extreme tiredness
- Loss of consciousness
SCAD is a medical emergency because it can lead to a heart attack or cardiac arrest. Call 911 and get to a hospital’s emergency department (do not drive yourself) immediately if you experience any signs or symptoms of SCAD.
What Causes SCAD?
The cause of SCAD (spontaneous coronary artery dissection) is not always known.
Risk factors for developing SCAD include:
- Gender: About 80% of patients are female
- Age: more common in people in their 40s and 50s
- Recent childbirth
- Giving birth to multiples (quadruplets or more)
- Fibromuscular dysplasia and other blood vessel conditions such as dissection, tortuosity, and aneurysms
- Extreme physical distress including intense exercise and intense Valsalva-type activities (such as straining during a bowel movement, blowing up a balloon, or playing a wind instrument)
- Extreme emotional distress
- Connective tissue disorders such as Marfan or vascular Ehlers-Danlos syndrome
- Systemic inflammatory conditions
- Hormonal changes such as those brought on by menopause
- Hormonal therapy
- Recreational drug use
How Is SCAD Diagnosed?
SCAD (spontaneous coronary artery dissection) is diagnosed with a history and physical examination, along with tests such as:
What Is the Treatment for SCAD?
Treatment for SCAD (spontaneous coronary artery dissection) depends on:
- Symptoms that are present
- The size and location of the tear
- The amount of damage to the heart
Conservative therapy is preferred and some patients may just need monitoring and the condition will go away on its own.
When treatment is needed, medications used to treat SCAD include:
- Cholesterol-lowering medications
- Blood pressure-lowering medicines
- Medications to control chest pain (such as nitro lingual spray)
Surgery may be needed to repair the damage. Surgery for SCAD may include:
- Insertion of a stent to open up the artery
- Coronary artery bypass graft (CABG) surgery, in which a grafted vessel lets the blood flow bypass the blockage
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