Spontaneous Coronary Artery Dissection (SCAD): Symptoms, Causes, Treatment

What are the symptoms of spontaneous coronary artery dissection?

Spontaneous coronary artery dissection (SCAD) is a condition where a tear forms in the inner layer of a coronary artery, leading to reduced blood flow and potentially a heart attack. The symptoms of SCAD can vary but commonly include:

• Chest Pain: This can be severe, sudden, and may be described as pressure, squeezing, or aching in the chest.
• Shortness of Breath: Difficulty breathing or a feeling of breathlessness may occur.
• Nausea and Vomiting: These symptoms can accompany chest pain.
• Sweating: Profuse sweating, often referred to as cold sweats, can occur.
• Fatigue: Unexplained tiredness or fatigue, sometimes severe, can be a symptom.
• Lightheadedness or Dizziness: A feeling of faintness or dizziness might be experienced.
• Palpitations: Sensations of rapid or irregular heartbeats can be present.

In some cases, SCAD can be asymptomatic or present with symptoms that are not immediately recognized as heart-related. It’s important for individuals experiencing any of these symptoms, especially if they are sudden and severe, to seek medical attention promptly for an accurate diagnosis and appropriate treatment.

What are the causes of spontaneous coronary artery dissection?

The exact cause of spontaneous coronary artery dissection (SCAD) is not fully understood, but several factors and conditions are believed to contribute to its development:

• Underlying Vascular Conditions: Conditions like fibromuscular dysplasia (FMD), a disease affecting the blood vessels, are associated with SCAD.
• Hormonal Factors: Hormonal changes, especially those related to pregnancy, menopause, or hormonal therapies, may increase the risk.
• Connective Tissue Disorders: Conditions such as Ehlers-Danlos syndrome or Marfan syndrome, which affect connective tissues, can predispose individuals to SCAD.
• High Blood Pressure: Chronic hypertension may contribute to the risk of arterial dissection.
• Trauma: Though not always a direct cause, physical trauma or intense physical activity could potentially contribute to the development of SCAD.
• Genetic Predisposition: There may be a genetic component, as SCAD can occur in families, suggesting a hereditary link.
• Stress: Emotional or physical stress might play a role in the occurrence of SCAD, though this connection is still being studied.

These factors can create conditions in which the inner layer of the coronary artery tears, leading to reduced blood flow and potentially causing a heart attack or other cardiac symptoms.

What is the treatment for spontaneous coronary artery dissection?

The treatment for spontaneous coronary artery dissection (SCAD) focuses on managing symptoms, preventing complications, and supporting healing. The approach can vary depending on the severity of the dissection and the patient’s overall health. Treatment strategies include:

• Medications:
• Antiplatelet agents like aspirin or clopidogrel are commonly used to prevent blood clots.
• Anticoagulants might be prescribed in some cases to reduce clotting risk.
• Beta-blockers or ACE inhibitors can help manage blood pressure and reduce strain on the heart.
• Pain relievers may be used to manage chest pain.
• Lifestyle Modifications:
• Diet and exercise adjustments to improve cardiovascular health and reduce risk factors like high blood pressure.
• Stress management techniques to help reduce emotional and physical stress.
• Monitoring and Follow-Up:
• Regular follow-up with a cardiologist to monitor heart function and the status of the dissection.
• Imaging studies, like echocardiograms or MRIs, to assess the progression or resolution of the dissection.
• Invasive Procedures:
• Coronary angioplasty and stenting may be necessary if the dissection causes significant blockage of the coronary arteries.
• Coronary artery bypass grafting (CABG) could be considered in severe cases, though it is less common.
• Supportive Care:
• Management of any associated conditions or complications, such as heart failure or arrhythmias.

In many cases, SCAD resolves on its own with conservative management, but the treatment plan should be individualized based on the patient’s specific condition and needs.