It may feel like a heart attack, but it may not be: Spontaneous Coronary Artery Dissection (SCAD)

Imagine that you are a generally healthy person, without any particular illness or pain, going about your daily routine. You exercise, eat well, and drink. But suddenly, unexpectedly, you feel a sharp pain in your chest, a tightness. You start sweating, you have difficulty breathing, and you feel pain that goes down your arm. What is the first thing that comes to your mind? "Oh, am I having a heart attack?" Isn't that the fear? But these symptoms are not always the same as the symptoms of a normal heart attack that we know. Today, we are going to talk about a medical emergency that looks similar, but is a little different, especially among young, healthy women. We call this `Spontaneous Coronary Artery Dissection` or `(SCAD)` for short.

Simply put, what is SCAD?

Although the name may sound a bit complicated, it's actually pretty easy to understand what's going on. Think of our heart as a motor that's constantly working. This motor needs a constant supply of blood, which means oxygen and nutrients, to work. This blood is carried to the heart muscles by blood vessels that are like a small pipe system. These are what we call the coronary arteries.

Now, although this coronary artery is like a tube, its wall is made up of three layers that are glued together. Like a layer cake. In the case of SCAD, what happens is that, for no apparent reason, a small tear suddenly forms in one of the layers on the inside of this artery wall.

Imagine what happens when the inside of a water pipe is slightly torn. The water pressure causes water to leak through the tear and get trapped between the two walls of the pipe. Similarly, when there is a tear in an artery, blood flowing under high pressure leaks between these two membranes and collects. When blood gets trapped in this way, it bulges into the artery wall at that point, blocking the blood flow. This is called a ``hematoma``. When the blood flow becomes narrowed or completely blocked in this way, the amount of blood that reaches the heart muscle decreases. That is when the symptoms of a heart attack that we talked about earlier appear.

What are the symptoms of this? How do you recognize it?

The symptoms of SCAD are very similar to those of a normal heart attack, so it's easy to confuse the two. But if you experience any of these symptoms, it's important to treat it as a medical emergency .

Who is most at risk for developing SCAD?

This is the most surprising thing about SCAD. Heart attacks usually occur in people who are older, have risk factors like diabetes, high blood pressure, and cholesterol. But SCAD is not like that.

• Most common in women: Out of 10 SCAD patients, 9 are women.
• At a young age: This condition is common, especially among women between the ages of 40-50, who are healthy and have no other heart disease risk factors.
• Pregnancy-related: Some women may develop this condition during pregnancy or after giving birth. It is believed to be caused by hormonal changes and the stress of childbirth.
• Severe physical or mental stress: Sudden lifting of heavy weights, strenuous exercise, or severe emotional trauma or sadness can be triggers for a SCAD condition.
• Other medical conditions: People with Fibromuscular Dysplasia (FMD) (a disease that weakens the walls of blood vessels), connective tissue diseases like Marfan syndrome, and lupus are also at risk.

How does the doctor diagnose this?

When you go to the emergency room, the first thing doctors do is check to see if you're having a heart attack. They do a number of tests to determine if you have a heart attack. A special test is needed to accurately diagnose SCAD.

How is it treated? How long does it take to recover?

The treatment for SCAD is a little different than treating a regular heart attack. Surprisingly, most cases of SCAD resolve on their own over time with medication, without any surgery or major procedures. The body can heal the torn artery on its own.

Treatment methods

• Drug treatment: Medications such as aspirin to prevent blood clots, beta-blockers to control heart rate and blood pressure and relax the arteries, and medications to control chest pain are key.
• Hospitalization: The patient is kept in the hospital's intensive care unit or ward for several days, and the heart's function is carefully monitored.
• Angioplasty and Stenting: This is done much less frequently. Only if the artery is completely blocked and the patient's life is at risk, a balloon is used to inflate the artery and a mesh-like device (stent) is inserted to keep it open.
• Bypass Surgery: This is rarely done for SCAD.

The recovery time varies from person to person. You will usually have to stay in the hospital for about 3-5 days. It can take several weeks or even months for the torn artery to fully heal. However, it is very important to follow the doctor's instructions carefully during this time.

After recovery

Even after recovery, you will need to continue to go to the clinic under the supervision of a cardiologist.

• Cardiac Rehab: This is very important. This program helps you exercise safely under medical supervision, adopt a heart-healthy diet, and manage stress.
• Lifestyle changes: Your doctor may advise you to avoid heavy lifting and activities that put a lot of strain on your body.

When a SCAD occurs, it's normal to feel anxious and worried, wondering, "Will something like this happen again?" Talk openly about this with your doctor. Seek psychological counseling if necessary.