Can an artery in your heart suddenly rupture? Let's learn everything about SCAD (Spontaneous Coronary Artery Dissection)!

Have you ever wondered how a healthy, well-exercised person could suddenly develop a heart attack? Or how a healthy young woman who has just become a mother could suddenly experience chest pain? Today we're going to talk about a somewhat strange, but very important heart condition. This is what we call SCAD, or Spontaneous Coronary Artery Dissection .

What is SCAD (Spontaneous Coronary Artery Dissection)? Let's understand it very simply.

Simply put, SCAD is a sudden tear or separation between two layers in the wall of the coronary arteries that carry blood to our heart. Think of it this way: a blood vessel is like a thin tube. The wall of this tube is made up of several layers. In SCAD, one of these layers tears and blood leaks between them. What happens then? That blood collects and leaks into the vein. It inflates like a balloon. As a result, the blood flow to the heart becomes blocked, or it starts to move very slowly.

This is like a small tumor growing inside a water pipe and blocking it. Then the heart doesn't get the oxygen and nutrients it needs.

SCAD increases your risk of a condition called Acute Coronary Syndrome (ACS) . This is also a type of coronary artery disease. This can cause chest pain, or angina . It can also lead to a heart attack, which can be life-threatening.

What do these words mean?

If we look at the meaning of these three words SCAD separately, you will understand this disease better.

• Spontaneous: This means that it happens suddenly, without any warning .
• Coronary Arteries: These are the main blood vessels that supply our heart with oxygen-rich, clean blood. We have two main coronary arteries, the left and right. They divide into smaller branches.
• Dissection: In medicine, this word refers to the separation of tissue into layers, such as tearing.

Do you understand? That means, we call this SCAD when a blood vessel in the heart suddenly ruptures from within for no apparent reason.

What is Acute Coronary Syndrome?

This is not one disease. It is a general term for several different conditions in which blood flow to the heart is suddenly reduced. This often happens when plaque, which is a build-up of fat inside the arteries (also known as atherosclerosis or "hardening of the arteries") suddenly ruptures. This can lead to life-threatening conditions such as heart failure, heart attack, or stroke .

How common is this condition called SCAD?

Medical experts say that SCAD is an underdiagnosed condition. It is estimated that about four out of every hundred people who develop acute coronary syndrome (ACS) (4%) have SCAD. In addition, SCAD is the cause of about one in four (25%) ACS cases in women under the age of 50! This means that it may be more common in younger women than you think.

Why does SCAD occur? What are the causes?

Experts still don't know exactly what causes SCAD. Surprisingly, many people who develop this condition are young, fit, and healthy. They also don't have any prior heart disease.

Some SCAD patients are recently given birth . It has also been found that SCAD is more likely to occur during menstruation or postmenopause . Therefore, there is a suspicion that changes in female hormones may play a role in this.

SCAD is very rare in men, occurring in less than ten percent (10%). In men, this tear often occurs after intense exercise (strength training) or lifting a heavy object . This physical exertion can tear the wall of the vein.

Very rarely, this artery wall can rupture due to severe vomiting or the force of coughing. Sometimes, a coronary artery can rupture due to a traumatic accident or during a medical procedure such as cardiac catheterization . However, there is a reason for this.

Who is at higher risk of developing SCAD?

People with certain medical conditions are at higher risk of developing a coronary artery rupture. Let's look at what they are:

• Connective tissue diseases - for example , Marfan syndrome .
• High blood pressure (Dangerously high blood pressure).
• Fibromuscular Dysplasia (FMD) - This is a disease that affects the arteries.
• Decreased thyroid function ( Hypothyroidism ).
• Inflammatory diseases - examples include lupus , multiple sclerosis (MS) , and sarcoidosis .
• Substance use disorders .

What are the symptoms of SCAD? How are they diagnosed?

When blood flow to the heart is reduced due to SCAD, it can lead to a heart attack or a type of chest pain called unstable angina . This type of angina is very dangerous because it increases the risk of a heart attack.

SCAD is a medical emergency that requires immediate treatment. If you have any of the following symptoms of a heart attack, call 911 immediately (in Sri Lanka, call the Suwaseriya Ambulance Service at 1990):

• Dizziness or fainting ( syncope ).
• Excessive sweating ( Hyperhidrosis ) or feeling cold.
• Heart palpitations or arrhythmia .
• Musculoskeletal pain in the arm, shoulder, or jaw area.
• Nausea and vomiting, or a feeling of stomach upset ( indigestion ).
• Shortness of breath.
• Chest tightness, pressure, or pain.

These symptoms are exactly the same as those of a heart attack. So, if you experience something like this , don't delay.

How is SCAD diagnosed? (Diagnosis)

Diagnosing SCAD can be challenging. If you have chest pain or other symptoms of heart disease, your doctor may order tests like these to check for SCAD:

• Enzyme marker test: Checks for elevated levels of certain cardiac enzymes that accumulate in the blood during a heart attack.
• Angiogram: This allows you to see the blood flow in your heart in three-dimensional (3D) moving images. This may include a Coronary Computed Tomography Angiogram (CCTA) or a Magnetic Resonance Angiogram (MRA) .
• Intravascular Optical Coherence Tomography (IVOCT): This allows the artery to be examined from the inside out.
• Intravascular Ultrasound (IVUS): This can produce very clear, detailed images inside the arteries.

These tests are what allow doctors to determine exactly whether you have a torn coronary artery or another heart condition.

How is SCAD treated?

Most people with SCAD, about three-quarters (75%), recover with medication. These are the types of medication given:

• Blood pressure medications (e.g., beta blockers ).
• Medications that control high cholesterol levels.
• Medications that prevent blood clotting ( antiplatelet medications ).

However, approximately 14% of people with SCAD can develop a serious condition. Such people may need to be hospitalized and receive emergency treatment. Such treatments include:

• Cardiac catheterization , followed by coronary angioplasty and stent placement . This involves inflating the blocked blood vessel with something like a balloon and placing a small mesh (stent) to prevent it from getting blocked again.
• Coronary Artery Bypass Grafting (CABG): This involves creating a new path for a blocked blood vessel.
• Installing a mechanical circulatory support device, such as a Left Ventricular Assist Device (LVAD) , or an Implantable Cardioverter Defibrillator (ICD) .
• Heart transplant - This is very rare.

Most of the time, doctors try to manage the condition with medication, allowing the torn artery to heal on its own. Surgery is only considered necessary if absolutely necessary.

Can SCAD be prevented?

If you've had a torn artery once, you may need to limit some strenuous physical activities and strength training to prevent it from happening again. Your doctor may also refer you to a cardiac rehabilitation program . This can help improve your heart health and teach you how to exercise safely.

Although no direct link has been found between SCAD and hormonal birth control, many doctors recommend considering nonhormonal birth control options first. For example, a vasectomy for men or tubal ligation for women. Ask your doctor which method is best for you.

You can also do these things to reduce your risk of heart disease:

• Eat a heart-healthy diet to lower cholesterol levels.
• Reduce salt intake and control high blood pressure.
• Limit your alcohol consumption. If you have a problem with alcohol use, get help.
• Be aware of the types of fats you consume and reduce your intake of unhealthy fats.
• If you have diabetes , control it well.
• If you smoke, get help to quit.
• Stay physically active and maintain a healthy weight.

What is the outlook for someone with SCAD?

SCAD is a life-threatening condition. About 5% of people who develop it die. Tearing a vein can lead to the following risks:

• Chronic angina: A small number of people may experience persistent chest pain or pressure. This may not respond well to traditional medications such as nitroglycerin .
• Disease recurrence: About one in ten (10%) people will develop SCAD again within three years of their first treatment. Your doctor will do regular tests to try to detect these tears early.
• Heart inflammation: SCAD can cause inflammation of the sac around the heart, called pericarditis . Your doctor may order tests like cardiac MRIs or angiograms to check for this problem.

Therefore, it is very important to follow medical instructions exactly and undergo tests on time after developing SCAD.

When should I see a doctor?

If you think you are having a heart attack, call 911 (1990 in Sri Lanka) immediately.

Additionally, see a doctor if you have any of these symptoms:

• Chest pain or pressure ( Angina ).
• Cold sweat.
• Pain in the arms, jaw, or shoulders.
• Difficulty breathing.
• Feeling extremely tired, dizzy, or weak for no reason.

What should I ask my doctor?

If you are diagnosed with SCAD, you may want to ask your doctor these questions:

• What caused me to develop this SCAD?
• Can I get SCAD again?
• What should I do to protect my heart health?
• Should I be concerned about symptoms of complications?

SCAD is a condition that causes symptoms similar to a heart attack in people who are at low risk of heart disease, especially women. Call emergency medical services immediately if you have symptoms of a heart attack. If tests confirm that you have SCAD, your doctor will talk to you about treatment options. Even with treatment, there is a risk that the artery will rupture again. Your doctor will monitor your heart health closely to reduce that risk.

Take-Home Message

Okay, so we've talked a lot about SCAD, haven't we? Here are some of the most important things to remember:

• SCAD is a sudden, unexpected heart attack that can affect young, healthy women in particular.
• The symptoms are exactly like a heart attack. If you have chest pain, difficulty breathing, or sweating, don't ignore them. Seek medical advice immediately.
• Diagnosing SCAD can be a bit complicated, but it can be confirmed with the right tests.
• It can often be cured with medication, but some people may need surgery or other treatments.
• It is very important to make lifestyle changes and follow medical advice after SCAD. This can reduce the risk of recurrence.

If you or someone you know has these symptoms, don't panic and see a doctor without delay. The sooner you get diagnosed, the more likely it is that treatment will be successful. Stay healthy!

` Spontaneous Coronary Artery Dissection, SCAD, heart attack, chest pain, coronary artery, women's health, emergency care