Coronary artery dissection is a serious heart disease that requires urgent treatment. This condition occurs when one of the arteries in the heart develops a rupture of its inner lining – one of the three walls of the artery.
One type of coronary artery dissection is called spontaneous coronary artery dissection (SCAD). This occurs when the rupture of the inner shell causes blood to build up between the layers. This can lead to the formation of a blood clot that blocks blood flow to the heart muscle. Blood clots can also grow with the accumulation of platelets and other substances.
This type of dissection sometimes occurs in the aorta, the large artery that supplies blood from the heart to most of the body. When this happens, the condition is called aortic dissection.
SCAD is more common in women over 50 or after menopause, according to a 2015 review. But it is also a common cause of heart attack in pre-menopausal women. Studies from 2014 show that aortic dissection is most common among men in their 60s and 70s. But both conditions can develop at any age.
Read on to learn more about the symptoms, types, causes and treatment of SCAD.
The symptoms of aortic dissection and SCAD are similar to the signs of a heart attack and include:
- chest pain
- Lack of air
- pain in one or both hands
- pain in the shoulders, neck or jaw
- cold sweat
- nausea
- dizziness
Sudden, severe chest pain and shortness of breath should always be treated as a medical emergency – even if other symptoms are not present or do not seem so serious.
When to seek emergency medical help
If you think you or your loved one are having a heart attack, call 911 or your local emergency services immediately.
Pain associated with aortic dissection, unlike SCAD or heart attack, can feel as if something is tearing or splitting in your chest.
In contrast, heart attack pain is often described as a feeling of pressure, heaviness, or tightness.
Symptoms of aortic dissection may also look more like a stroke than a heart attack, such as:
- weakness or numbness on one side of the body
- difficulty speaking or understanding speech
- vision problems
- dizziness, near fainting or fainting
These are common patterns of symptoms for these conditions, but there may be variations. Because there is significant overlap of symptoms between SCAD, aortic dissection, and heart attack, symptoms alone cannot diagnose them.
Each of these conditions is potentially life-threatening and requires immediate medical attention. At the hospital, doctors will be able to perform a physical examination and tests to determine the root cause of your symptoms.
It is not always clear why SCAD or other types of arterial dissections occur, although there are some risk factors.
For example, a 2021 study found that women are much more likely than men to develop SCAD. Most women who experience SCAD are in their 40s and 50s, but people who are pregnant or have recently given birth are also at higher risk for SCAD.
Men are more likely than women to have aortic dissection.
A 2019 study notes that the following conditions increase the risk of both SCAD and coronary artery dissection:
Other risk factors for SCAD and other types of arterial dissections include poorly controlled high blood pressure, atherosclerosis and other vascular conditions.
Intensified exercise, especially weightlifting, has also been identified as a risk factor for SCAD and aortic dissection.
SCAD is often diagnosed for the first time when someone has a heart attack. The first steps in diagnosing a heart attack include:
- electrocardiogram (ECG) to monitor the electrical patterns and rhythms of your heart
- blood test to measure troponin, a protein that is released into your bloodstream after a heart attack
SCAD is present in about 1 in 4 heart attacks in women under the age of 60. A person with symptoms of a heart attack can be assessed for atherosclerosis, narrowing and hardening of the arteries. According to the American Heart Association, if atherosclerosis is not detected, the doctor should test for SCAD.
Coronary angiography is the main method for diagnosing SCAD. As part of this invasive test, a thin plastic tube called a catheter is inserted into your artery. A special dye is injected into the blood through this catheter, which can only be detected by X-rays. A coronary angiogram can detect blood flow problems and can often show the location of the dissection and its severity.
According to a 2014 study, intravascular ultrasound (IVUS) is often used in conjunction with coronary angiography to confirm the diagnosis of SCAD. This type of imaging can help assess the exact location and degree of rupture in an artery.
IVUS is a catheter-based procedure performed under a mild sedative. A small tube with an ultrasound probe at the end is inserted into the heart and directed by your doctor. This probe sends signals to a computer, creating cross-sectional images. These images provide a 360-degree real-time view of the heart area being imaged. IVUS is often used to guide stent placement to treat blocked arteries.
Physicians may also diagnose aortic dissection using one or more of the following imaging tests:
If your doctor finds that your aortic dissection is mild and that no immediate intervention is needed, he or she may prescribe certain medications to lower your blood pressure and slow your heart rate.
Medications to treat mild SCAD also include antihypertensive drugs and blood thinners to reduce the risk of a blood clot forming at the tear site.
If the medication is not enough to treat the condition, surgery or a catheter-based procedure may be needed to treat the damaged artery.
For SCAD, open heart surgery can be performed to bypass the damaged artery with a blood vessel elsewhere in the body.
Aortic dissection can be corrected surgically. If the aortic valve in the heart is also damaged, a replacement valve may need to be inserted.
In addition to medical therapy and invasive procedures, the Canadian Heart and Stroke Foundation says managing coronary artery dissection or SCAD often means adopting certain behaviors for heart health.
Some important lifestyle changes include:
- regular exercise approved by a doctor
- avoid lifting heavy weights and contact sports
- maintaining a moderate weight
- following a heart-healthy diet, such as the Mediterranean diet
- monitor your blood pressure with medication if necessary
- reduction or cessation of smoking if you smoke
- stress reduction
- attending cardiac rehabilitation
A 2017 study says a doctor may recommend taking beta-blockers along with some of these lifestyle changes. Also, visit a cardiologist regularly to monitor your heart health.
Healthy arteries are essential to make sure you have adequate blood flow throughout your body.
If the coronary artery ruptures, the heart muscle may be damaged due to a reduction in oxygen-rich blood. If the aorta ruptures, the consequences can be fatal without surgery.
But SCAD and aortic dissection are often treatable if you get immediate medical attention. Then follow your doctor’s instructions for medications and lifestyle changes to prevent further heart complications.
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