Spontaneous Coronary-Artery Dissection (SCAD) is an uncommon newly-recognized condition, not well understood. There’s no blockage, but rather a coronary artery suddenly splits apart lengthwise, causing a heart attack (Myocardial Infarction, M.I.). It usually occurs among people with other unusual diseases (e.g. Fibromuscular Dysplasia, affecting arterial walls), but can occur disproportionately among younger women with no risk factors for heart disease. Symptoms are those of a heart attack (M.I.): abrupt chest pain with sudden cold sweat on forehead, shortness of breath, lightheadedness, or nausea.
What’s so tricky about SCAD is many clinicians are unaware of it, so don’t realize that younger women can occasionally have full-blown heart attacks. If they realize the possibility, diagnosis is relatively straight-forward: call 911, and in the ER do an EKG draw blood for cardiac enzymes (troponins). However, since these tests may be false-negative up to 25% of the time, it’s important to continue on to the cardiac catheterization, which can directly see the cardiac arteries. If that’s normal, it may be necessary to perform even more sophisticated tests, such as intravascular ultrasound, or optical coherence tomography (OCT).
Most patients with SCAD survive, so treatment is usually with medications, instead of stents or surgical coronary bypass. However, SCAD can recur, causing future heart attacks. Survivors often wind up suffering additional conditions such as migraine headaches, anxiety, depression, or post-traumatic stress disorder. As such, ongoing support is extremely important.