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A heart attack that strikes younger healthy women

July 26, 2019 | UCI Health
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Heart attacks aren’t supposed to happen to younger people, especially women under age 50 who are physically fit with no prior indication of heart problems.

However, there is one heart condition that strikes younger women: spontaneous coronary artery dissection, or SCAD. 

SCAD, which is a tear in the innermost layer of an artery wall, is the leading cause of heart attacks in younger women. This rare condition often affects pregnant women, new mothers and otherwise healthy athletes. Most of the time, the tear in the artery may heal on its own.

But if left undiagnosed, SCAD can cause severe damage to the heart and lead to death.

“Just as many women have heart attacks as men, and up to 25% to 30% of those cases can be due to SCAD,” says UCI Health interventional cardiologist Jin K. Kim, MD, PhD, who specializes in heart disease, noninvasive cardiovascular imaging and women’s heart health.

Causes of SCAD

Whereas a classic heart attack is usually caused by blockage due to atherosclerosis, or plaque buildup, a SCAD heart attack is due to a different type of blockage, one that results from a tear in the innermost layer of an artery wall.

As blood flows into the torn layer, a blockage forms, interrupting blood flow to the heart and causing a heart attack.

Who is at risk for SCAD?

SCAD most commonly affects:

In many cases, the cause of SCAD is unidentifiable, making diagnosis particularly challenging.

SCAD can happen in a normal artery,” Kim says. “It is very hard to determine who will develop this condition. The exact mechanism of SCAD is not really known at this point. We know how it happens — a tearing of two layers of the walls that make up the blood vessel in the coronary artery — but why it happens is really not clear.”

Kim explains that there may be an association between SCAD and conditions such as:

  • Extreme emotional stress
  • Extreme physical stress, such as during pregnancy or a difficult labor and delivery
  • Drug use disorder

Symptoms of an arterial dissection

Women diagnosed with SCAD experience symptoms similar to stress, anxiety, panic attacks, acid reflux or other life-threatening conditions. Because of this, the condition is often misdiagnosed.

Other symptoms include:

  • Chest pain or uncomfortable pressure in the chest
  • Light headedness, fainting
  • Nausea, vomiting
  • Pain that radiates to the shoulders, neck, or arms
  • Palpitations
  • Shortness of breath

If you are having chest discomfort, shortness of breath, or pain in your neck or jaw — symptoms that you have not experienced before — Kim recommends contacting your primary care physician or cardiologist immediately.

Diagnosing SCAD

If you or your doctor suspects you are having a heart attack, a blood test should be administered to detect blood damage and diagnostic imaging may be performed.

To help diagnose SCAD, Kim and other UCI Health interventional cardiologists also perform optical coherence tomography (OCT), a noninvasive diagnostic imaging technique that is not widely available elsewhere.

Treatment options for SCAD

The good news is that the majority of SCAD cases with no blockage do not require any immediate intervention at all.

 “If there is good blood flow in the affected artery, about 70% to 80% of SCAD cases will heal on their own,” Kim says.

To help in the healing process, she recommends:

  • Mild blood thinner therapy to prevent more blood clots from forming
  • Medication to control pain

If SCAD is diagnosed and there is a blockage of blood flow, the primary goal of treatment is to open up the blocked artery to return or improve blood flow. Options include:

  • Stenting, in which a small metal tube is inserted into the artery to keep it open
  • Bypass surgery

Bypass surgery is a procedure to repair very large tears and restore blood flow. Vessels from the chest wall or legs are used to circumvent the blockage. But Kim says this surgical approach is very rare.

Prognosis for SCAD patients

The prognosis for patients diagnosed with SCAD is very good. “The reported mortality rate is low, less than 2% to 4%,” Kim says

However, once SCAD happens, the rate of a new tear in another artery can be up to 5% per year, which is why she advises women who have experienced SCAD to monitor their hearts closely and stay in tune with their bodies and overall health. 

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