Spontaneous coronary artery dissection: The leading cause of pregnancy-associated heart attacks

Despite increased awareness over the past decades, only about half (56%) of women recognize that heart disease is their No. 1 killer. Heart disease is the leading cause of death for women in the United States, accounting for 1 in every 5 female deaths.

Healthy, young and pregnant women can suffer severe and deadly heart attacks for different reasons. Approximately one-third of heart attacks in women younger than 50, and the leading cause of pregnancy-associated heart attacks, is a condition known as spontaneous coronary artery dissection, SCAD. SCAD is a previously little-known condition, but a potential devastating cause of heart attacks in young women. Read below to find out what SCAD is, who is at risk and the signs to look for.

What is spontaneous coronary artery dissection (SCAD)?

Spontaneous simply means the condition forms without warning. Coronary arteries are blood vessels that supply blood and oxygen to your heart. You have two coronary arteries, one on the left side and one on the right side of your heart. Dissection is a medical term for tissue separation.

Spontaneous coronary artery dissection, SCAD, occurs when a tear or separation forms in the wall of a coronary artery. The tear leads to a disruption of blood flow to the downstream heart muscle which becomes deprived of oxygen. This disruption can cause a heart rhythm problem (also known as arrythmias), a heart attack or sudden death.

Who is at risk for SCAD?

SCAD is spontaneous rupturing of the blood vessels surrounding the heart. Hence, any condition that weakens the blood vessel wall can increase the risk of rupture. Common risk factors include:

• Female sex: SCAD can occur in both men and women, but it tends to affect women more.

• Childbirth: SCAD has been found to occur most often in the first few weeks after delivery, but it can also occur during pregnancy and up to six months after childbirth.

• High blood pressure: Hypertension can be associated with SCAD.

• Hormone use: Oral contraceptives and infertility treatments have been associated with SCAD.

• Inflammatory diseases: Autoimmune diseases that attack the body's blood vessels, such as systemic lupus erythematosus and polyarteritis nodosa, also have been associated with SCAD.

• Fibromuscular dysplasia (FMD): A condition that causes irregular growth of cells in artery walls can weaken artery walls, leading to blockages and ruptures. Women are more likely to have this condition than men.

• Inherited connective tissue diseases: Genetic diseases that cause problems with the body's connective tissues, such as vascular Ehlers-Danlos syndrome and Marfan syndrome, have been found to occur in people who have had SCAD.

• Extreme physical or emotional stress

What are the symptoms of SCAD?

Chest pain is the most common symptom, occurring in more than 95% of people with SCAD. Here are other common symptoms of SCAD:

• Chest pain
• Pain in the arms, shoulders, back or jaw
• Shortness of breath
• Rapid heartbeat
• Sweating
• Fatigue
• Nausea
• Dizziness

How is SCAD diagnosed?

The first test of screening includes blood work and an electrical recording of your heart, an EKG and ultrasound (echo). In certain cases, a doctor also might order a test called a coronary angiogram. This involves placing a wire through the artery of your wrist or groin and shooting dye into the blood vessels of your heart. The best set of tests will be determined by your healthcare team.

How is SCAD treated?

In most cases, medications are used. In rare exceptions, doctors might use invasive procedures and surgery. More research is needed to determine the best treatment options because SCAD is a newly recognized form of a heart attack.

In addition, a prescribed exercise program called cardiac rehabilitation may be used to help people who have had SCAD or other heart diseases to aid recovery and improve their health.

Am I at risk for complications?

SCAD can happen more than once, despite successful treatment. If it happens again, the timing is variable, either soon after the first episode or years later. People who have SCAD and want to get pregnant are also at risk for another cardiac event as well other problems, such as heart failure. If you are planning to get pregnant and have had SCAD in the past, it is important you meet with a team of doctors to come up with a personalized approach moving forward.

If you are experiencing heart attack symptoms, seek emergency medical attention immediately, even if you think you are not at risk.