A torn blood vessel in the heart can cause a heart attack. Learn about the diagnosis and treatment of this medical emergency.
Spontaneous coronary artery dissection is an emergency condition that occurs when a tear forms in a wall of a heart artery. Spontaneous coronary artery dissection also is called SCAD.
SCAD can slow or block blood flow to the heart, causing a heart attack, heart rhythm problems or sudden death.
SCAD most commonly affects women in their 40s and 50s, though it can occur at any age and can occur in men. People who have SCAD often don't have risk factors for heart disease, such as high blood pressure, high cholesterol or diabetes.
SCAD can cause sudden death if it isn't treated promptly. Get emergency medical help if you have heart attack symptoms — even if you think you aren't at risk of a heart attack.
Symptoms of SCAD can include:
Call 911 or your local emergency number if you have chest pain or think you might be having a heart attack. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Do not drive yourself unless you have no other choice.
The cause of spontaneous coronary artery dissection is unknown.
Risk factors for SCAD include:
A possible complication of SCAD is heart attack. SCAD slows or stops blood flow through an artery. This weakens the heart and may lead to a heart attack. A heart attack from SCAD is different from a heart attack caused by a buildup of fats, cholesterol and other substances in and on the artery walls. This condition is called atherosclerosis.
In some people with SCAD, the inner and outer layers of the artery may split. Blood can collect between these layers. Pressure from the pooled blood can make SCAD worse.
Even with successful treatment, SCAD can happen more than once. It might happen soon after the first episode or years later. People who have SCAD also may have a higher risk of other heart problems. These problems include heart failure due to the heart attack damage.
In spontaneous coronary artery dissection, also called SCAD, a tear forms in an artery in the heart. This can cause blood to pool in the area between the layers. SCAD can reduce or block blood flow through the artery, which can cause a heart attack. A heart attack as a result of SCAD is different from a heart attack caused by atherosclerosis.
SCAD is usually diagnosed in an emergency setting. You may be asked questions about your personal and family medical history. Tests are done to check your heart.
Tests to diagnose SCAD are similar to tests used to detect a heart attack. They may include:
Other tests may be done during a coronary angiogram to confirm SCAD and plan treatment. These tests include:
In a cardiac catheter procedure, a doctor inserts a flexible tube called a catheter into a blood vessel. Sometimes it's placed in the wrist artery, called the radial artery. Or it may be placed in an artery in the groin, called the femoral artery. The catheter is then guided to the heart.
The goals of SCAD treatment are to:
Treatment may include medicines and a procedure or surgery to open the artery and restore blood flow. Sometimes SCAD heals on its own.
The type of treatment for SCAD depends on your overall health and the size and location of the tear in the artery.
Some people with SCAD only need medicines to treat symptoms. If chest pain or other symptoms continue, other treatments also might be needed.
Medicines to treat SCAD may include:
Some people with SCAD need a surgery or procedure to fix the artery and improve blood flow to the heart. These treatments may include:
Coronary angioplasty (AN-jee-o-plas-tee) and stent. This treatment may be needed if SCAD blocks blood flow to the heart or medicines don't control chest pain.
During the procedure, a doctor places a long, thin flexible tube called a catheter in a blood vessel, usually in the groin or wrist. It's guided to the heart. A small balloon on the tip of the catheter widens to open the artery. Then, the doctor places a tiny mesh tube called a stent inside the artery. The stent holds the artery open and improves blood flow. The balloon is removed. The stent stays in place. Another name for this treatment is percutaneous coronary intervention or PCI.
If you've had SCAD, talk to a health care professional before becoming pregnant. Pregnancy may not be safe after having SCAD.
After treatment for SCAD, you need regular checkups with your health care team.
A personalized program of exercise and education may be suggested. This is called cardiac rehabilitation, also known as cardiac rehab. It's created to help you recover from a serious heart condition. The program often includes supervised exercise, emotional support and education about a heart-healthy diet.
It's important to take steps to keep the heart healthy. Try these tips:
Some people might feel scared, sad, frustrated or depressed after having SCAD. Understanding your health and talking to others may help. Try these tips:
You may not have time to prepare. SCAD usually is diagnosed in an emergency situation. If you have chest pain or think that you're having a heart attack, immediately call 911 or your local emergency number.
After a SCAD diagnosis, you may have questions about your health. Prepare a list of questions to ask your health care provider at your next appointment, such as:
Don't hesitate to ask other questions you have.