Spontaneous coronary artery dissection (SCAD)
Spontaneous coronary artery dissection (SCAD) occurs when blood flow in the heart slows or stops because of a tear in the wall of an artery. Read about SCAD symptoms, causes and treatment, and hear from people who have experienced it.
Spontaneous coronary artery dissection (SCAD) is a rare, but life-threatening, condition which affects the coronary arteries, the vessels that provide oxygenated blood to the heart.
SCAD occurs when there is a tear in the inner lining of a coronary artery. Blood then flows through the tear, pooling between the inner and outer linings of the artery. This reduces blood flow through the artery, sometimes blocking it completely.
This reduction in blood flow can cause:
Most people who experience SCAD recover fully if their condition is diagnosed quickly and treated correctly. However as SCAD can result in cardiac arrest, it’s important you call 111 immediately if you experience any signs of symptoms, even if you don’t think you’re at high risk of heart disease.
What are the symptoms of SCAD?
SCAD happens suddenly and without warning. The signs and symptoms can closely resemble a heart attack caused by coronary artery disease. These symptoms may include:
- Chest pain
- Heaviness or tightness in chest
- Pain or discomfort in arms, neck, jaw, back or stomach
- A rapid heartbeat or fluttery feeling in chest
- Shortness of breath
- Nausea and sickness
- Extreme tiredness
- Loss of consciousness
Because SCAD can be life threatening, call 111 for an ambulance if you’re suffering any of these symptoms – even if you don’t have the typical heart disease risk factors. Do not wait to see a GP.
What causes SCAD?
Doctors and researchers are still unsure of the exact cause of SCAD. However there are some factors that put you at greater risk. These include:
- Gender Approximately 80% of people with SCAD are women.
- Age It‘s more common in people in their 40s and 50s, although it can affect people of any age.
- Having recently given birth Some women experience SCAD in the first few weeks after giving birth.
- Fibromuscular dysplasia and other blood vessel conditions There’s an association between SCAD and fibromuscular dysplasia and other blood vessel conditions.
- Extreme physical or emotional distress There’s an association between SCAD and people who have recently experienced extreme emotional or physical distress. This association is not yet fully understood.
- Genetics Researchers believe there may be a genetic predisposition (a greater likelihood of developing it if someone else in your family has had it) but this this not yet fully understood.
- Hormonal changes Hormonal changes brought on by menopause are thought to contribute to the risk of SCAD.
Many people who experience SCAD have few or no risk factors for coronary artery disease, which is the most common cause of heart attacks.
If you’re experiencing heart attack symptoms you’ll probably receive an electrocardiogram (ECG) to measure the electrical activity in your heart and blood tests to measure your troponin levels.
Doctors will also use imaging to locate the tear in your coronary artery and measure its size. These scans may include:
- an angiogram, during which dye is inserted into the arteries to reveal areas of blockage
- an echocardiogram, which uses sound waves to produce video images of your heart pumping
- a cardiac computerised tomography (CT) scan and/or a magnetic resonance imaging (MRI) scan to provide more detailed images of the heart if necessary.
How is SCAD treated?
SCAD treatment will depend on:
- the size and location of the tear
- your symptoms
- the amount of damage to the heart.
The aim of the treatment is to restore full blood flow to your heart. In some cases this will occur naturally, either without any treatment, or with medication alone. Managing your condition this way is safe and it is the preferred option.
If you are prescribed medication, it may include:
- cholesterol-lowering medication
- blood pressure-lowering agent
- blood-thinning medication
- medication to control chest pain (such as nitro lingual spray).
Not everybody will require medication. Your specialist will discuss your individual case and treatment plan with you.
Sometimes surgery may be needed to repair the damage. This could include having a stent inserted to open up the artery or coronary artery bypass surgery, in which a grafted vessel lets the blood flow bypass the blockage.
After you’ve been discharged from hospital, you’ll have regular follow-up appointments with your cardiology team to monitor your condition. These appointments are a great opportunity to discuss any concerns or questions you may have. Sometimes it’s a good idea to write down anything you want to discuss and take the list with you.
It’s very common for people to wonder whether SCAD will happen again. SCAD reoccurs in about 10% of people who have experienced it once. In rare cases, it may occur on multiple occasions. Subsequent dissections are more likely to occur within the first few months of the first event, with the risk reducing as time goes by. The good news is that the large majority of people who have experienced SCAD go on to live healthy lives without further problems.
Exercise and activity after SCAD
You may feel anxious about returning to exercise – especially if you were exercising when your SCAD occurred. However some form of regular exercise is important for your ongoing physical and mental health. If you haven’t already, it’s a good idea to discuss exercise with your cardiac team.
Moderate aerobic activities such as swimming, cycling and running are usually safe. However there are some activities which you will need to avoid. These include:
- those that have abrupt starts and stops, e.g. high intensity training or sports
- those that cause very quick increases in blood pressure, e.g. heavy weight-lifting
- activities which increase the risk of sudden, rapid, or severe neck motion, e.g. rollercoasters
- activities that maintain the neck in an extended position for a prolonged period of time, e.g. certain yoga positions.
It’s important your exercise plan is safe for you, so you’ll need to discuss it with your cardiac nurse specialist or your cardiologist.
A green prescription is another way to get exercise advice. The green prescription is a free government-run programme, that gives you access to a qualified exercise coach. You can find out how to contact your local green prescription provider on the Ministry of Health website.
Attending a cardiac rehabilitation class is a great way to learn more about recovering from a heart event, and meet others in a similar situation.
Unfortunately cardiac rehabilitation is not currently provided in all areas of New Zealand.
Connecting with other SCAD survivors
Connecting with others who have experienced SCAD is a good way to understand more about your condition and relieve anxieties you may have.
You can read personal stories from people who have had SCAD and have shared their story for articles on our website or as part of our Journeys programme. You may also benefit from the opportunity to share your story with others.
There are a number of online SCAD support groups on Facebook (you will need to be signed in to Facebook to access some of these pages):
There is also an online international SCAD community board.
Please note, these are not Heart Foundation pages, nor are they endorsed by the Heart Foundation. They are online support groups and should not be used as alternative to clinical advice.
National and international research into SCAD is ongoing. If you want to participate or find out more email Mandy Fish at Auckland District Health Board or phone +64 9 307 4949 ext 24366.Read about people living with SCAD