HEART MONTH 2022: Understanding SCAD (spontaneous coronary artery dissection)

Published: Feb. 9, 2022 at 2:42 PM EST
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AUGUSTA COUNTY, Va. (WHSV) - S.C.A.D., or a spontaneous coronary artery dissection, can be a serious condition that can lead to a heart attack.

“It involves a tear in the innermost portion of the blood vessel. That causes a separation between the outer portion of the blood vessel and blood pools and builds up between those two areas and that can cause a bulge or narrowing of the artery. That decreases blood flow and can even block blood flow to the heart muscle,” Dr. LeAnn Denlinger, an attending cardiologist for Augusta Health, said.

Unlike a common heart attack, the artery is not narrowed by plaque build-up but rather blood pooling between the layers of the artery.

When blood flow to the heart decreases, that can result in a heart attack which can weaken the heart muscle, dangerous heart rhythms and even sudden cardiac death.

“When patients have SCAD, they can experience typical symptoms of a heart attack like chest pains, chest pressure, shortness of breath. However, people can also have atypical symptoms, such as extreme or unusual fatigue, dizziness, nausea, and vomiting,” Dr. Denlinger added.

S.C.A.D. usually has an abrupt or acute presentation and is most commonly found in women.

“I didn’t have any warning signs or anything, it just happened,” Gretchen Wolfinger said.

Gretchen had SCAD a few months before her 64th birthday.

“I had no other symptoms of a heart attack or any other serious condition like a stroke. I wasn’t lightheaded, I didn’t go unconscious. I had an ache in my chest and not real pain. I could have sat there with the ache in my chest, I just knew it was serious,” Gretchen explained.

“Most patients do not have the traditional risk factors for heart failure or disease such as high blood pressure, high cholesterol diabetes,” Dr. Denlinger explained. “SCAD patients are usually healthy, most commonly it affects women in the fourth to fifth decade of life.”

Experts say the reason behind SCAD can be a little unclear. Dr. Denlinger says it can be related to a number of factors including genetics, hormonal influences and environmental stressors.

“Extreme physical stress like extreme exercise. Sometimes patients recall a specific emotional stressor like an unexpected death in the family. In addition, some patients can experience SCAD, especially young women, during labor and delivery or with breastfeeding. Some of those precipitators or stressors make us think that maybe SCAD is related to some hormonal influences,” Dr. Denlinger said.

Dr. Denlinger says the tear can heal over several weeks.

“Some of the complications of SCAD include decreased heart function and abnormal arrhythmias. Sometimes those improve once that heart vessel heals. In addition, the recurrence of SCAD is relatively high. About 20% of patients with SCAD can have a recurrence of SCAD within two to three years,” Dr. Denlinger said.

About one percent of heart attacks are caused by SCAD. Given how SCAD presents in the body, Dr. Denlinger says it is really important to get to a hospital as soon as possible, if you are having symptoms.

“We have a saying in cardiology that time is tissue,” she said. “The longer amount of time you wait to go to a hospital the more tissue damage can occur during a heart attack.”

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