Spontaneous Coronary Artery Dissection (SCAD)

Spontaneous coronary artery dissection, although rare, is a serious condition that occurs when there is a tear in the inner wall of a coronary artery (supplies applied oxygen-rich blood to the heart). 

This tear creates a false lumen, an abnormal channel within the arterial wall, causing blood to flow inside the layers of the artery wall. This leads to compression of the true lumen (the normal channel), restricting blood flow to the heart muscle.

It typically affects otherwise healthy individuals with no history of heart problems and can result in acute coronary syndrome, heart attack, arrhythmias, or sudden cardiac death. SCAD is most commonly observed in women, particularly those between the ages of 30 and 60, and it can occur during or shortly after pregnancy. 

It has also been linked to fibromuscular dysplasia (FMD), connective tissue disorders, extreme physical stress, and emotional stress.

Common Signs That Indicate SCAD

• Chest pain or discomfort
• Pain in the arm, neck, back, or jaw
• Shortness of breath
• Nausea
• Sweating
• Dizziness or lightheadedness
• Rapid heartbeat (palpitations)
• Fatigue
• Loss of consciousness (in severe cases)

What Can Lead to SCAD?

• Tear in the coronary artery wall: A spontaneous break in the innermost layer of the artery leads to blood accumulation within the wall, forming a false lumen and compressing the true lumen.
• Fibromuscular dysplasia (FMD): A non-atherosclerotic arterial condition that weakens artery walls and is strongly associated with SCAD, especially in women.
• Peripartum and postpartum state: Hormonal and hemodynamic changes during and after pregnancy can weaken coronary vessels, increasing susceptibility.
• Extreme emotional stress: Severe psychological distress can trigger a spike in blood pressure and heart rate, contributing to vessel wall rupture.
• High-intensity physical exertion: Intense exercise or sudden strain has been linked to SCAD in some cases, especially in otherwise healthy individuals.
• Connective tissue disorders: Ehlers-Danlos syndrome or Marfan syndrome, can structurally weaken artery walls, making them prone to tearing.
• Use of certain hormones or medications: Hormonal therapy or certain vasoconstrictive drugs may influence vascular tone and increase risk.
• Underlying arteriopathies or vascular inflammation: Some patients exhibit signs of vascular abnormalities not directly linked to FMD, but these suggest an underlying predisposition.
• Spontaneous with no identifiable trigger: In many cases, no single cause is found, and the dissection occurs without any known underlying condition.

How SCAD Is Diagnosed?

• Coronary angiography: This is the primary diagnostic tool used in suspected cases of SCAD. A dye is injected in the coronary arteries through a catheter, allowing real-time X-ray imaging. It helps detect irregularities, such as tapered narrowing or dissection flaps. However, some SCAD cases may resemble atherosclerotic narrowing, so interpretation requires expertise.
• Intravascular ultrasound (IVUS): An ultrasound probe is inserted into the artery to generate cross-sectional images of the vessel wall. It can confirm the presence of a false lumen or an intramural hematoma when angiographic findings are unclear.
• Optical coherence tomography (OCT): This test uses light waves to provide high-resolution images of the artery's inner layers. OCT is beneficial for visualizing small tears or subtle dissections not easily seen with angiography or IVUS. It's often used when the diagnosis is uncertain.
• Electrocardiogram (ECG): Detects electrical changes in the heart that suggest a heart attack or lack of oxygen due to reduced blood flow. ST-segment changes or T-wave inversions may be observed.
• Cardiac biomarkers (blood tests): Blood is tested for markers like troponin and CK-MB, which are elevated when heart muscle damage occurs. While not specific to SCAD, elevated levels support the suspicion of an acute coronary event.
• Echocardiogram (echo): An ultrasound of the heart is used to assess overall heart function and detect complications, such as reduced ejection fraction, wall motion abnormalities, or pericardial effusion, following a SCAD.
• CT coronary angiography: It may be used in certain low-risk patients or follow-up scenarios. This non-invasive imaging can visualize the coronary anatomy, though it is less definitive than catheter-based angiography.
• Screening for associated conditions: Once SCAD is confirmed, additional testing (e.g., CT or MR angiography of the head, neck, and abdomen) may be performed to evaluate for fibromuscular dysplasia or other vascular abnormalities across different body regions.

Treatment Approaches for SCAD 

• Conservative medical management (preferred in stable cases): Most SCAD patients are treated without invasive procedures, except if blood flow to the heart is preserved (TIMI flow grade 2–3). The artery often heals on its own over time. Close monitoring in a cardiac care unit is standard during the acute phase of care.
• Antiplatelet therapy: Aspirin is commonly prescribed long-term to prevent clot formation in the affected artery. A second antiplatelet agent (like clopidogrel) may be used for a limited period based on clinical judgment.
• Beta-blockers: The medications reduce heart rate and blood pressure, lowering the mechanical stress on artery walls. They may also reduce the risk of SCAD recurrence.
• Nitrates or calcium channel blockers (if needed): Used to control chest pain or coronary artery spasm, especially when angina persists after the acute event.
• Avoidance of thrombolytics: Fibrinolytic drugs are generally avoided in SCAD, as they can worsen bleeding into the vessel wall, expand the dissection, and increase the risk of complications.
• Percutaneous coronary intervention (PCI): Reserved for high-risk cases where the artery is severely blocked or the patient is unstable. Stenting in SCAD can be technically challenging due to fragile vessels and extended dissections, with higher complication rates than in typical heart attacks.
• Coronary artery bypass grafting (CABG): Considered only in severe cases involving critical left central artery dissection or multivessel SCAD when PCI is not feasible. It is rarely required.
• Cardiac rehabilitation: Structured rehab programs help patients regain confidence, safely return to daily activities, and manage emotional stress. Psychological support is also encouraged due to the traumatic nature of the event and the often young age of patients.
• Lifestyle adjustments and recurrence prevention: Patients are advised to avoid intense physical exertion, manage stress effectively, and monitor their blood pressure regularly. Follow-up imaging may be used to monitor the healing process.
• Hormonal considerations in women: In women who developed SCAD during pregnancy or while using hormonal therapy, future use of hormonal contraceptives or fertility treatments should be discussed carefully with a cardiologist.

Ongoing Management of SCAD Patients

• Regular cardiology follow-ups: Routine check-ups are crucial for monitoring heart function, reviewing medications, and evaluating progress over time.
• Repeat imaging (if indicated): Follow-up coronary imaging may be done to confirm healing of the artery, especially if symptoms persist or recur.
• Structured cardiac rehabilitation: Participating in medically supervised rehabilitation helps restore physical stamina, manage anxiety, and reduce the risk of recurrence.
• Medication adherence: Long-term use of beta-blockers and low-dose aspirin is often recommended to support vessel stability and mitigate future risk.
• Avoidance of extreme physical stress: High-intensity workouts, heavy lifting, and sudden exertion should be avoided; instead, patients are advised to adopt moderate, consistent physical activity routines.
• Stress management and mental health care: Psychological counseling or therapy is encouraged due to the emotional impact of SCAD, especially in younger individuals who were previously healthy.
• Monitoring for recurrence symptoms: Any return of chest pain, shortness of breath, or some other cardiac symptoms should be promptly evaluated and addressed.
• Assessment for related conditions: Further evaluation for fibromuscular dysplasia or other vascular disorders may be needed if not already done.
• Hormonal guidance for women: Women who experienced SCAD related to pregnancy or hormone therapy may need specialist input before using hormonal contraceptives or planning future pregnancies.

Long-Term Outlook

Most people recover well from SCAD, especially with early diagnosis and appropriate management. The affected artery often heals naturally within weeks to months, and many patients regain normal heart function. 

However, SCAD does carry a risk of recurrence, with studies showing repeat episodes in up to 10–30% of patients over time. Ongoing medical follow-up, lifestyle modifications, and adherence to prescribed medications are crucial in reducing this risk. 

While the condition can be life-altering, especially for younger individuals with no prior heart issues, long-term outcomes are generally favorable when managed carefully.

Daily Life and Adjustments

Living with SCAD means adapting to a new normal with careful attention to heart health. Most people can return to regular activities over time, but they’re encouraged to pace themselves, avoid high-intensity physical strain, and prioritize stress management. 

Cardiac rehabilitation plays a key role in building physical and emotional resilience. Staying connected with a cardiologist, taking medications as advised, and recognizing early warning signs are essential parts of daily life. 

Emotional recovery is just as important—many patients benefit from support groups or therapy to cope with anxiety or fear of recurrence. With the proper support and lifestyle choices, most people with SCAD go on to lead whole, active lives.

Sterling Hospital is Your Partner in Heart Health Across Gujarat

At Sterling Hospital, we provide you with the utmost care and comfort throughout your journey to a healthier heart. If you are looking for the best  cardiovascular surgeons in Ahmedabad, Vadodara, Rajkot, or  Gandhidham, we've got you. 

With considerable years of experience, we have built a team of the best cardiologists in these regions to provide you with premium treatment and the best results. Contact Sterling Hospital to schedule a consultation and embark on a journey towards a healthier heart.