Though health enthusiasts usually tread with caution regarding diets and healthy lifestyles, an unexpected tear in the heart’s blood vessels can lead them to an emergency room. This condition is called spontaneous coronary artery dissection (SCAD).
SCAD is a sudden heart attack that requires prompt treatment. This coronary artery condition has often been linked as a cause of heart attack (acute myocardial infarction) in young and middle-aged women.
A condition like SCAD is a big health threat because people who have experienced it usually don’t have any risk factors like high blood pressure, cholesterol or heart disease.
Dr Sanjay Chugh, senior consultant and associate director of cardiology and interventional cardiology, Narayana Healthcare Superspeciality Hospital, Gurugram, Haryana, explains that SCAD is an emergency condition that arises when a tear forms in a blood vessel in the heart leading to a heart attack. “Because of the tear, blood flow to the heart muscle could be reduced or cause blockage. This could also lead to arrhythmia (irregular heartbeats) or sudden death,” explains Dr Chugh.
What is spontaneous coronary artery dissection?
Though clot formation and arterial blockages are common in both SCAD and atherosclerosis, the underlying cause of a heart attack varies in both. In atherosclerosis, plaque deposits cause blockage of coronary arteries while in SCAD a tear in the inner layer of heart vessels (intima) is the reason for arterial blockage.
According to Dr Chugh, SCAD can occur when there is stress on blood vessels of the heart due to some weakness in the tissues that make up the inner layers.
In SCAD, when the tear is caused in the artery, the blood flow creates a split between the layers of blood vessels and accumulates between these layers which can result in the clotting of blood.
“When the blood flow in the artery is obstructed or slows down, the heart muscle can die resulting in heart attack,” explains Dr Dimpu Edwin Jonathan, consultant interventional cardiologist, Aster RV Hospital.
Dr Chugh recalls the case of a 35-year-old female – a doctor and swimming enthusiast. He narrates how as soon as she plunged into the pool, she experienced a sharp pain in her chest while trying to stay afloat. Her husband, also a doctor (a cardiologist), wasted no time in getting her to the hospital and examinations revealed a 100 percent blockage in front artery of heart (Left Anterior Descending Artery). An angioplasty was done to save her life.
“In most people the tear may start some time back and lead to accumulation of blood within the vessel wall. When the vessel wall tears the clot formation could suddenly result in heart attack,” explains Dr Chugh.
According to an article published in Cardiovascular and Interventional Radiological Society of Europe’s, an aortic dissection is a tear that separates the inner wall of the aorta and forms two channels: the original channel and a new channel in the aortic wall. When there is high blood pressure in the new channel, it compresses the original channel which leads to organ failure and restricted blood supply to the lower limbs.
What causes SCAD?
While women are more prone to SCAD some other causes associated with SCAD are high BP, pregnancy, hormone use in women or connective tissue disorder. People who use cocaine and other substance abusers are also prone to SCAD.
“It has also been observed that many tobacco users are also likely to get affected by this condition,” adds Dr Chugh.
Dr Jonathan explains another cause leading to SCAD could be Fibromuscular dysplasia (FMD). This condition can damage or weaken artery walls due to extra cell growth in the artery walls. The blood vessels become twisted and obstruct the blood flow. This leads to blockages, bulging and aortic dissection (tear) which can be fatal.
Signs and symptoms
A person affected by SCAD may experience symptoms like chest pain, palpitations, shortness of breath and dizziness. Other symptoms include sweating, pain in the arms, back, jaw or shoulders while some serious SCAD related risks are heart attack, arrhythmia and heart failure.
Treatment
According to Dr Chugh, one usually gets to know of this condition after the artery blocks off and causes symptoms. Sometimes you learn about it only after a heart attack.
“This may be detected on angiography for reasons like chest pain evaluation or angina,” adds Dr Jonathan.
An angioplasty is done if the person is having a heart attack; otherwise, they are put on blood thinners. “Very rarely a bypass surgery will be done apart from the treatment of arrhythmias,” explains Dr Chugh.
Takeaways
Commonly seen in women in their forties or fifties, spontaneous coronary artery dissection (SCAD) is an emergency condition when a sudden tear forms in the heart’s artery. This tear can stop or slow the blood flow to the heart, causing sudden heart attack.
