A spontaneous coronary artery dissection is a medical emergency triggered by a blood vessel tear. As this occurs, it can partially or completely block the blood supply to the heart, leading to a heart attack. SCAD for short, spontaneous coronary artery dissection is most frequently seen in women above the age of 40, but it can also occur in men at any age.
Symptoms and causes of a spontaneous coronary artery dissection
SCAD is a spontaneous condition that can occur in healthy people, even those who don’t have risk factors for heart disease. It requires immediate medical attention because it can otherwise lead to death.
Because of that, it’s very important for people who have the symptoms below to seek medical attention immediately:
- Angina (chest pain)
- Shortness of breath
- Dizziness
- Nausea, sometimes combined with vomiting
- Extreme fatigue
- Pain the jaw, arms, or shoulders
- A rapid heartbeat or chest fluttering
The exact causes of SCAD are yet to be identified. When it occurs, it means that the inner lining of the artery walls become separate from the outer layer, and blood accumulated between them. Because this blood exerts pressure, it can increase the gap between the artery layers. It is also likely for this blood to form clots.
When SCAD occurs, the blood flow to the heart slows down, meaning that the heart’s muscle grows weaker and weaker. The condition can also block the blood supply to the heart permanently, which is what causes a heart attack.
Note that a heart attack caused by atherosclerosis is different from one that occurs as a consequence of spontaneous coronary artery dissection.
Spontaneous coronary artery dissection: Risk factors
Research has surfaced some similarities between people who experienced a SCAD, but the role that each of the following factors plays in the equation isn’t entirely clear. Some of the more common risk factors for this medical emergency include:
- Gender. While SCAD can occur in both men and women, the latter gender is more likely to be affected by it.
- Physical exhaustion. Intense exercise can cause a SCAD.
- Giving birth. Some women who had recently given birth experienced a SCAD, particularly in the first weeks after having the baby.
- Blood vessel problems. There are certain blood vessel abnormalities that can cause a SCAD (such as fibromuscular dysplasia — irregular cell growth in the artery walls).
- Hypertension. Elevated blood pressure has been linked to SCAD.
- Illicit drug use. Drugs such as cocaine or methamphetamine can increase the risk of SCAD.
Diagnosis of spontaneous coronary artery dissection
The tests that doctors use to identify a SCAD are similar to those used to diagnose other heart problems. These include:
- Coronary angiogram. This specific test is basically an X-ray that requires the injection of a special dye that travels through the arteries, to make them more visible during the examination. The test uses the same type of catheter that’s also used during angioplasty. When reaching the arteries of the heart, the dye is released, and the X-ray machine will reveal any artery problems that may indicate a SCAD, such as tortuous coronary arteries (vessels that are abnormal or twisted).
- Optical coherence tomography. By using a catheter, the doctor uses light to recreate the network of your arteries.
- Cardiac computerized tomography angiography. If you’ve ever done a CT scan before, you probably know what to expect as far as this cardiac test is concerned. It’s basically an x-ray machine that requires the patient to lie down on a table that slides into a tube. During the test, a moveable X-ray will take pictures of the chest and heart, being able to reveal artery abnormalities.
- Intravascular ultrasound. With the help of a catheter, the doctor that create sound-wave pictures of the arteries. This test is generally an addition to the coronary angiography.
Treatment for spontaneous coronary artery sissection
The main purpose of SCAD treatment is to make sure that the blood flow to the heart is restored. This could mean that you need to undergo an invasive procedure, but some people manage to heal from spontaneous coronary artery dissection naturally.
If the signs and symptoms you’re experiencing aren’t severe, you will most likely receive a list of prescribed drugs to help treat the condition. As far as medication is concerned, doctors can prescribe aspirin, hypertension medication, angina-relieving drugs, blood thinners, a cholesterol-lowering medication, and others.
If the problem requires immediate intervention, doctors may choose to perform either an angioplasty with stent placement or coronary artery bypass surgery.The angioplasty is a procedure that requires doctors to forcefully open the coronary arteries that are blocked, by inserting a catheter that goes all the way to the site of the blockage. At the end of the catheter lies a small mesh tube, which is known as a stent, and which will permanently be placed inside the artery. With X-ray guidance, the doctors will place the stent at the problematic location. A balloon attached to the catheter will be inflated in order to push the walls of the blocked artery further apart from one another, and then the stent is felt there to keep the arteries open.
In case the doctors choose the part of coronary artery bypass, your chest will be open and a healthy vessel extracted from another body part will be used to redirect blood around the blockage. One end of the healthy vessel is attached before the blockage, and the other end, immediately after it. This way, blood will have a new path to follow, avoiding the blockage inside the artery.