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Spontaneous coronary artery dissectionBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/spontaneous-coronary-artery-dissection/DS01209
Spontaneous coronary artery dissection — sometimes referred to as SCAD — is a rare emergency condition that occurs when a tear forms in one of the blood vessels in the heart.
Spontaneous coronary artery dissection can slow or block blood flow to the heart, causing a heart attack, abnormalities in heart rhythm and sudden death.
Spontaneous coronary artery dissection tends to affect people ages 30 to 50, though it can occur at any age. People who develop spontaneous coronary artery dissection are often healthy, and many don't have risk factors for heart disease, such as high blood pressure and diabetes.
Spontaneous coronary artery dissection can lead to sudden death if it isn't diagnosed and treated promptly. For this reason, seek emergency attention if you experience heart attack signs and symptoms — even if you think you aren't at risk for a heart attack.
Signs and symptoms of spontaneous coronary artery dissection include:
- Chest pain
- A rapid heartbeat or fluttery feeling in the chest
- Pain in your arms, shoulders or jaw
- Shortness of breath
- Unusual, extreme tiredness
When to see a doctor
If you experience chest pain or suspect you're having a heart attack, immediately call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only as a last resort.
It's not clear what causes spontaneous coronary artery dissection.
Spontaneous coronary artery dissection causes a superficial tear inside an artery. When the inner layers of the artery separate from the outer layers, blood can pool in the area between the layers. The pressure of the pooling blood can make a short tear much longer. And blood trapped between the layers can form a blood clot.
Spontaneous coronary artery dissection may slow blood flow through the artery to the heart, which makes the heart work harder. Or blood flow through the artery can be completely stopped, causing heart muscle to die (heart attack).
Doctors and researchers have found some similarities among people who have experienced spontaneous coronary artery dissection. It's not yet clear what role these factors play in causing the disease. Common factors include:
- Female sex. Though spontaneous coronary artery dissection can occur in both men and women, it tends to affect women more often.
- Giving birth. Some women with spontaneous coronary artery dissection have recently given birth. Spontaneous coronary artery dissection was found to occur most often in the first few weeks after delivery.
- Irregular growth of cells in the artery walls. A condition called fibromuscular dysplasia (FMD) causes the irregular growth of cells in the walls of one or more of your arteries. This irregular growth can weaken the artery walls and reduce blood flow. FMD can also cause high blood pressure, a stroke and tears in other blood vessels. FMD occurs more often in women than it does in men.
- Extreme physical exertion.
- Blood vessel problems. Diseases that cause inflammation of the blood vessels, such as lupus and polyarteritis nodosa, have been associated with spontaneous coronary artery dissection.
- Inherited connective tissue diseases. Genetic diseases that cause problems with the body's connective tissues, such as Ehlers-Danlos syndrome and Marfan syndrome, have been found to occur in people with spontaneous coronary artery dissection.
- Very high blood pressure. Having untreated, severe high blood pressure is associated with spontaneous coronary artery dissection.
- Cocaine use.
In some people, spontaneous coronary artery dissection can occur again, despite successful treatment. It may recur soon after the initial spontaneous coronary artery dissection or years later.
Doctors are studying why spontaneous coronary artery dissection recurs and who is most likely to experience a recurrence.
Preparing for your appointment
In most cases, spontaneous coronary artery dissection is an emergency situation. If you experience chest pain or suspect you're having a heart attack, immediately call 911 or your local emergency number.
In the days after your initial diagnosis, you're likely to have many questions about your situation. Because meetings with doctors can be brief, and because there's often a lot of ground to cover, it's a good idea to prepare by writing down your questions. Order them from most important to least important, in case time runs out.
Some questions you may want to ask include:
- What caused my spontaneous coronary artery dissection?
- What are other possible causes for my symptoms or condition?
- What kinds of tests do I need?
- What's the best treatment?
- Will the tear in my artery heal on its own?
- What are the alternatives to the primary approach that you're suggesting?
- Will I have another spontaneous coronary artery dissection?
- I have these other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- If I would like more children, is it safe for me to be pregnant?
- Should I see a specialist? What will that cost, and will my insurance cover it?
- Are there brochures or other printed material that I can take with me? What websites do you recommend?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions that occur to you.
Tests and diagnosis
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Tests and procedures used to diagnose spontaneous coronary artery dissection involve creating pictures of your arteries to look for signs of abnormalities.
Injecting special dye into the affected artery
During a set of procedures called cardiac catheterization and coronary angiogram, doctors inject a special dye into your arteries so they'll show up on imaging tests. To get the dye to your arteries, doctors insert a long, thin tube (catheter) into an artery — usually in your leg or arm — and thread the tube to the arteries in the heart.
Once the dye is released, doctors use X-rays to create pictures of the arteries. The X-rays may show abnormalities in an artery that help confirm spontaneous coronary artery dissection.
Creating images of the inside of arteries
After coronary angiogram, other tools may be inserted through the catheter and into the affected artery to create pictures. These imaging tests may include:
- Intravascular ultrasound. A special imaging catheter may be passed into your arteries to create sound-wave pictures (ultrasound).
- Optical coherence tomography. A catheter equipped with a special light may be passed into your arteries to create light-based pictures.
The images may show abnormalities in an artery that help doctors confirm spontaneous coronary artery dissection and gather information to guide treatment decisions.
Using advanced imaging to see the arteries
During a cardiac computerized tomography (CT) angiography scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest, which can show abnormalities in your arteries. Cardiac CT angiography may be used in addition to other tests and procedures.
Treatments and drugs
The goal of treatment for spontaneous coronary artery dissection is to repair the tear in your damaged artery and restore blood flow to your heart.
Which treatments are best for you will depend on your situation, including the size of the tear in your artery and its location, as well as any signs or symptoms you're experiencing. Whenever possible, doctors allow the damaged artery to heal on its own, rather than repairing it through invasive procedures.
After spontaneous coronary artery dissection, your doctor may recommend medications to restore blood flow to your heart. Medications can include:
- Blood-thinning drugs. Drugs that reduce the number of blood-clotting platelets in your blood (anticoagulants) reduce the risk of a clot forming in your torn artery.
- Blood pressure drugs. Drugs used to treat high blood pressure can lower your heart's demand for blood, reducing the pressure in your damaged artery. You may continue to take blood pressure drugs indefinitely to reduce the risk of another spontaneous coronary dissection.
For some people, medications may relieve symptoms of spontaneous coronary artery dissection. In these situations, it may be possible to forgo further treatment. If chest pain or other symptoms persist, other treatments may be needed.
Placing a stent to hold the artery open
If your spontaneous coronary artery dissection has blocked blood flow to your heart or if medications don't control your chest pain, your doctor may recommend placing a tiny mesh tube (stent) inside your artery to hold it open. A stent helps restore blood flow to your heart.
To position the stent, doctors insert a long, thin tube (catheter) into an artery — usually in your leg or arm — and thread the tube to the arteries in the heart. The catheter is guided to your damaged artery using X-rays or other imaging tests.
A wire with a deflated balloon is passed through the catheter to the tear in the artery. The balloon is then inflated, expanding the stent against your artery walls. The stent is left in place to hold the artery open.
Surgery to bypass the damaged artery
If other treatments haven't worked or if you have more than one tear in an artery, your doctor may recommend surgery to create a new way for blood to reach your heart.
Coronary artery bypass grafting is a procedure that involves removing a blood vessel from another part of your body, such as your leg. That blood vessel is stitched into place so that it diverts blood flow around your damaged artery.
After your treatment for spontaneous coronary artery dissection, your doctor may recommend other types of care to help you recover and to prevent other health problems. These may include:
- Undergoing cardiac rehabilitation. Cardiac rehabilitation is a customized program of exercise and education designed to help you recover from a serious heart condition, such as a heart attack caused by spontaneous coronary artery dissection. Cardiac rehabilitation often includes monitored exercise, nutritional counseling, emotional support and education.
- Reviewing your family medical history. Some inherited conditions, such as the connective tissue disease Marfan syndrome, have been found to occur in people who experience spontaneous coronary artery dissection. Your doctor may refer you to a genetic counselor to review your family medical history and determine whether genetic testing may be right for you.
- Looking for weaknesses in other blood vessels. Your doctor may recommend using CT scanning to look for weaknesses and abnormalities in other blood vessels, such as those in your neck and abdomen.
Coping and support
Spontaneous coronary artery dissection can be an unexpected and shocking diagnosis. The condition can cause serious and scary symptoms, and it often affects people who may have few risk factors for heart disease.
Each person finds his or her own way of coping with a diagnosis. In time you'll find what works for you. Until then, you might try to:
- Find out more about your diagnosis. Find out enough about spontaneous coronary artery dissection so that you can feel comfortable participating in decisions about your care. Ask your doctor for the specifics of your situation, such as the location and size of your artery tear and descriptions of the treatments you've received. Talk with your health care team about where you can find more information about spontaneous coronary artery dissection.
- Connect with others living with your diagnosis. Spontaneous coronary artery dissection is rare, but national organizations can help connect you to others who share your diagnosis. Organizations such as the American Heart Association and the National Coalition for Women with Heart Disease provide telephone and online support.
- Take care of yourself. Help your body recover by taking good care of yourself. For instance, get enough sleep so that you wake feeling rested, choose a healthy diet full of fruits and vegetables, and find healthy ways to cope with stress, such as listening to music or writing down your thoughts. If your doctor feels its safe, try gentle exercise most days of the week.
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