When you think of heart problems, you probably think of older women—especially those past menopause, when the risk of heart disease climbs precipitously.
But there is a rare heart condition that is more common in younger women between 30 and 50 years old—those who are relatively healthy with few or no risks for heart disease.
Known as spontaneous coronary artery dissection, or SCAD, it occurs when there’s a spontaneous tear in the coronary artery wall. Without an intact artery wall, blood flow is impeded and unable to pass through the innermost of the wall’s three layers. Instead, the blood bulges inward, narrowing or blocking the artery.
What happens next? Blood flow to the heart is blocked, and SCAD can cause a heart attack, heart rhythm abnormalities or even sudden death.
It can be surprising when SCAD occurs because many of its victims are otherwise healthy, showing no signs of clogged arteries and not having any other heart disease risk factors like high blood pressure, high cholesterol or diabetes.
Although researchers are not quite sure of the causes of SCAD, they do know certain things:
A hormonal link has been suggested by some studies, since SCAD affects women who have recently given birth or are close to their menstrual cycle. (SCAD can affect men, too, but is more common among women. When one hospital looked into the 440 cases of SCAD that occurred between 1931 and 2008, they found that 98 percent of the cases were in women.)
Other studies have found a link between a disorder called fibromuscular dysplasia and SCAD. Fibromuscular dysplasia is a blood vessel condition, caused by abnormal cell growth, that can cause problems in the arteries and weaken artery walls, leading to an aneurysm (when part of the artery wall weakens, then balloons out or expands abnormally), or a blockage or dissection.
Women with the conditions lupus or polyarteritis nodosa may also be more prone to SCAD. So can women with certain inherited connective tissue diseases (like vascular Ehlers-Danlos syndrome and Marfan syndrome).
Cocaine and other illegal drug use has also been linked an increased risk of SCAD.
Having very high blood pressure can increase your risk for SCAD.
SCAD must be recognized and treated promptly because it can occur spontaneously with little or no warning before it causes a heart attack, which, for many women, is the first symptom of SCAD. And since it’s usually against the nature for a young and healthy woman to think that symptoms could be a sign of a heart attack, it’s important to know that it’s possible, and to know the symptoms.
Symptoms of SCAD include:
Nausea or dizziness shortness of breath
Rapid heartbeat or a feeling of fluttering in your chest
Pain in your jaw, shoulder or arms
To make a definite diagnosis, health care professionals need to get a look at the artery from the inside out, which usually involves performing an intravascular ultrasound or optical coherence tomography screening.
Women who have had a heart attack due to SCAD (which is not considered a “typical” heart attack) are usually treated differently than people whose heart attacks are caused by hardening of the arteries (atherosclerosis). That’s because some experts think that a stent may lead to higher complications and lower success rates in SCAD patients.
Typically, heart attacks are treated with stents to hold the artery open or with bypass surgery. Treatments for heart attacks from SCAD are usually more conservative and include blood pressure control and medications like beta-blockers or blood thinners or letting the dissection heal. Ultimately, the treatment depends on the severity of the disease and could include surgery or stents.
Because SCAD can occur more than once (months or even years later) in spite of successful treatment and women with it are at a higher risk of future heart problems, it’s important to reduce or eliminate any risk factors as much as possible and stay on top of your health. The good news is that survival is generally good for women who survive the initial event of chest pain or a heart attack.
Research into the treatment and prevention of SCAD continues as doctors and researchers collect data to assess the long-term outlook and prognosis and discover more ways to treat and prevent this rare disease.