Spontaneous Coronary Artery Dissection (SCAD)

A relatively uncommon but potentially serious cardiovascular condition, spontaneous coronary artery dissection (SCAD) occurs when a tear develops in one of the coronary arteries, which supply blood to the heart muscle. The tear can potentially block the flow of blood through the artery, triggering a heart attack.

Also, though rare, a severe SCAD event may cause significant damage to the heart muscle, potentially contributing to the development of heart failure.

Because SCAD primarily affects young and middle-aged women, specialized care is paramount. The multispecialty team in the Women’s Heart Program at Tampa General Hospital’s Heart and Vascular Institute focuses exclusively on preventing, diagnosing and treating cardiac conditions that disproportionately affect females, including SCAD.

What Causes Spontaneous Coronary Artery Dissection?

Unlike traditional coronary artery disease, which is often associated with plaque buildup in the arteries, SCAD is characterized by a sudden and spontaneous tear in an arterial wall. The precise causes are not fully understood. Because the condition predominantly affects women, especially during and after pregnancy, many experts believe it may be influenced by fluctuating female hormone levels. Other possible contributing factors include:

• A weak spot in an arterial wall
• Coronary artery spasms (vasospasm)
• An underlying blood vessel condition, such as fibromuscular dysplasia
• Severe emotional distress
• Intense physical exertion

SCAD Symptoms

SCAD symptoms often mimic those of a heart attack and therefore warrant emergency medical attention. Some common signs include:

• Stabbing, sharp or crushing chest pain that may radiate to the back, neck, jaw or arm
• Difficulty breathing and shortness of breath
• Weakness, lightheadedness and overwhelming fatigue
• Profuse sweating (diaphoresis)
• Nausea and vomiting

SCAD Diagnosis

Usually, SCAD is diagnosed after other cardiac issues, such as an atherosclerotic blockage and heart attack, are ruled out. Because evidence of a coronary artery dissection may be seen in images, imaging typically plays a key role in the diagnostic process. After taking a detailed medical history, performing a physical examination and asking about the patient’s symptoms, risk factors and recent emotional and physical stressors, a physician may order various tests, including:

• Electrocardiogram (EKG)
• Coronary angiography
• Intravascular ultrasound (IVUS) and optical coherence tomography (OCT)
• Magnetic resonance imaging (MRI) scans of the heart and coronary arteries
• Computed tomography angiography (CTA)
• Echocardiogram

SCAD Treatment

SCAD treatment can vary based on the severity of the condition and its symptoms and the patient’s lifestyle and preferences. Common approaches include:

Conservative Management

If SCAD is not causing a significant arterial blockage and its symptoms are mild or absent, a physician may suggest close monitoring and lifestyle modifications, such as stress reduction, to reduce the risk of further arterial dissections.

Medications

A physician may prescribe antiplatelet agents, beta-blockers or angiotensin-converting enzyme (ACE) inhibitors to help manage symptoms, stabilize blood pressure or reduce the risk of blood clot formation.

Cardiac Rehabilitation

A physician may recommend a tailored program of structured exercise, education and support to improve the patient’s overall heart health and reduce their cardiovascular risk factors.

Interventional Procedures

If SCAD is causing a significant arterial blockage, a percutaneous coronary intervention (PCI) or stent placement may be considered to restore blood flow.

Coronary Artery Bypass Grafting (CABG)

If multiple arteries are affected by SCAD, a CABG procedure may be performed to reroute the flow of blood around the damaged areas.

Long-Term Monitoring

SCAD patients typically require ongoing follow-up so their physician can continually assess their heart health and the status of their coronary arteries and adjust their treatment plan as needed.

Benefit From World-Class Care at TGH

Given the rarity and complexity of SCAD, it is important to seek care from a specialist who has expertise in diagnosing and treating it. At TGH, we take cardiac issues to heart. The multispecialty team in our Women’s Heart Program provides female-focused heart healthcare ranging from preventive screenings and medication management to complex surgeries and emergency interventions. Due in part to our commitment to delivering outstanding cardiac care, U.S. News & World Report has recognized TGH as “High Performing” in Cardiology and Heart Surgery and ranked us among the Top Hospitals in the Nation for Heart Failure and Heart Attack Care for 2023-24.

If you would like to learn more about spontaneous coronary artery dissection, contact us at (813) 844-3900 to request an appointment with a specialist on our team.