What is Spontaneous Coronary Artery Dissection or SCAD

Don’t worry — you’re just tired and out of sorts after having your baby. But the chest pain experienced by the woman you’re about to meet was much more than a difficult recovery. She had a heart attack when a rare and deadly condition stopped blood flow to her heart. The same thing happened to another woman. After sharing their stories on social networking sites they found more women with the same problem. That’s when they contacted Mayo Clinic to convince cardiologists to use the information they gathered on the internet to research this condition.

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A spontaneous coronary artery dissection (SCAD) (occasionally coronary artery dissection)

is a rare, sometimes fatal traumatic condition, with eighty percent of cases affecting women. One of the coronary arteries develops a tear, causing blood to flow between the layers which forces them apart. Studies of the disease place the mortality rate at around 70%.

SCAD is a primary cause of myocardial infarction (MI) in young, fit, healthy women (and some men) with no obvious risk factors. These can often occur during late pregnancy, postpartum and peri-menopausal periods.

Signs and symptoms

The symptoms are often very similar to those of myocardial infarction (heart attack), with the most common being persistent chest pain.

Causes

SCAD

There is evidence to suggest that a major cause of spontaneous coronary artery dissection (SCAD) is related to female hormone levels, as most cases appear to arise in pre-menopausal women, although there is evidence that the condition can have various triggers. Other underlying conditions such as hypertension, recent delivery of a baby, fibromuscular dysplasia and connective-tissue disorders (e.g., Marfan syndrome and Ehlers-Danlos syndrome) may occasionally result in SCAD. There is also a possibility that vigorous exercise can be a trigger. However, many cases have no obvious cause.

Pathophysiology

Coronary artery dissection results from a tear in the inner layer of the artery, the tunica intima. This allows blood to penetrate and cause an intramural hematoma in the central layer, the tunica media, and a restriction in the size of the lumen, resulting in reduced blood flow which in turn causes myocardial infarction and can later cause sudden cardiac death.

Diagnosis

A selective coronary angiogram is the most common method to diagnose the condition, although it is sometimes not recognised until after death.Intravascular ultrasound (IVUS) is also used as it is able to more easily differentiate the condition from atherosclerotic disease.

Treatment

Treatment is varied depending upon the nature of the case. In asymptomatic and hemodynamically stable patients it may be appropriate to maintain a conservative strategy, especially if coronarography demonstrates adequate coronary flow: in this situation spontaneous healing is usually the most probable evolution. In severe cases, coronary artery bypass surgery is performed to redirect blood flow around the affected area.  Drug-eluting stents and thrombolytic drug therapy are less invasive options for less severe cases. However PCI for spontaneous coronary artery dissection is associated with high rates of technical failure, so in many case a strategy of conservative management may be preferable.

Prognosis

The condition is often fatal and is mostly recognized at postmortem examination in young victims of sudden death.

Epidemiology

The prevalence of spontaneous coronary dissection varies from about 1% to 4% of all coronarography. About eighty percent of cases are in women, with an average age of around 40.

History

Spontaneous coronary artery dissection (SCAD) was first described in the year 1931, at postmortem examination, in a 42 year old woman.