HEART MONTH 2022: How cardiologists treat S.C.A.D.

Published: Feb. 17, 2022 at 10:06 AM EST
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AUGUSTA COUNTY, Va. (WHSV) - “We are on the clock as soon as the patient hits the door. We talk in cardiology terms about door to balloon time. Once the patient has first medical contact with the ambulance crew to me ballooning that blockage open, we want it as quickly as possible, within 90 minutes,” said Dr. April Shewmake with Augusta Health Cardiology.

Once physicians know a patient is on the way with heart attack symptoms, the clock starts on finding best treatment options.

Back in August 2021, Dr. Shewmake treated Gretchen Wolfinger for spontaneous coronary artery dissection, or SCAD. Wolfinger was having some chest pains and pressure. She knew something was very wrong.

When it comes to SCAD, the goal is to restore normal blood flow without further damage. With common heart attacks, doctors will use equipment to open up the vessel and use stents to keep it open. With SCAD, they tend to be more conservative.

“Often we will stop after we have made the diagnosis because if I put equipment down, I can make the tear worse. Every once in a while we do have to take the risk to stent the heart vessel open to maximize the recovery of the heart function,” Dr. Shewmake explained.

First, physicians must confirm SCAD has occurred. A catheter is put up through the artery arm, and doctors inject contrast dye to look for blockages.

“I can kind of tell the characteristics of the artery. Is this a blockage from cholesterol plaque build up or coronary artery dissection,” Dr. Shewmake said.

Depending on the condition of the tear, Dr. Shewmake has to decide the best course of action.

“It is better at that point to stop and support her with medications and other modalities in the ICU to try to help the heart recover from the insult,” Dr. Shewmake said. “Many of these arteries heal on their own within weeks just with the medications that we can give a patient.”

Beta Blockers have also been a successful treatment and have actually shown to prevent recurrence of SCAD. Ten percent of cases result in another tear.

“We help with water pills to get fluid out of the body. If we need to we can help with a breathing machine, when the heart is under strain and in the acute setting. Over the long term the body is a great healer which is fantastic, it does a lot of the work on its own,” Dr. Shewmake added.

Though the tear can heal on its own with proper medication, SCAD can cause sudden death if not treated.

“One of the scary things about SCAD, it happens in younger women who have no other risk factors and are otherwise completely healthy. It is associated with connective tissue disorders and other things that can be silent and hide until this event happens,” Dr. Shewmake said.

“You might think, ‘Oh I don’t want to go to the hospital.’ I don’t want to inconvenience myself. I can let it go on for a while. I don’t want to look foolish when the doctor says it is just indigestion. It is not worth it. If I had thought it was indigestion, I likely would have been dead if I waited much longer,” Wolfinger said.

Read more about what S.C.A.D. does to the heart by clicking here. For more information on cardiology at Augusta Health, click here.

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