Spontaneous coronary artery dissection (SCAD)

Maxwell Ademeyi

SPONTANEOUS coronary artery dissection (SCAD) occurs when blood flow in the heart slows or stops because of a tear in the wall of an artery.

SCAD is a rare but life-threatening condition which affects the coronary arteries, the vessels that provide oxygenated blood to the heart.

It occurs when there is a tear in the inner lining of a coronary artery. Blood then flows through the tear, pooling between the inner and outer linings of the artery. This reduces blood flow through the artery, sometimes blocking it completely. This reduction in blood flow can cause a heart attack, abnormal heart rhythms or cardiac arrest.

Symptoms

Spontaneous coronary artery dissection happens suddenly and without warning. The signs and symptoms can closely resemble a heart attack caused by coronary artery disease. These symptoms may include:

* Chest pain

* Heaviness or tightness in chest

* Pain or discomfort in arms, neck, jaw, back or stomach

* A rapid heartbeat or fluttery feeling in chest

* Shortness of breath

* Dizziness

* Sweating

* Nausea and sickness

* Extreme tiredness

* Loss of consciousness

Because this condition can be life-threatening, if you’re suffering any of these symptoms, even if you don’t have the typical heart disease risk factors, call for or seek medical attention urgently.

Causes

Generally, researchers are still unsure of the exact cause of this condition. However, there are some factors that put you at greater risk. These include:

* Gender: Approximately 80 per cent of people with spontaneous coronary artery dissection are women.

* Age: It is more common in people in their 40s and 50s, although it can affect people of any age.

* Having recently given birth: Some women experience this condition in the first few weeks after giving birth.

* Fibromuscular dysplasia and other blood vessel conditions: There is an association between the condition and fibromuscular dysplasia and other blood-vessel conditions. This condition causes weakening of the medium-sized blood vessels and increases the risks of aneurysms and dissection.

* Extreme physical or emotional distress: There is an association between spontaneous coronary artery dissection and people who have recently experienced extreme emotional or physical distress. This association is not yet fully understood.

* Genetics: Researchers believe there may be a genetic predisposition (a greater likelihood of developing it if someone else in your family has had it) but this is still under study. Ehlers-Danlos and Marfan syndromes are genetic conditions that have been found to occur in people who have had the disease.

* Very high blood pressure: Severe high blood pressure can raise the risk of this condition.

* Illegal drug use: Using cocaine or other illegal drugs might increase the risk of spontaneous coronary artery dissection.

* Hormonal changes: Hormonal changes brought on by menopause are thought to contribute to the risk of this condition.

Many people who experience spontaneous coronary artery dissection have few or no risk factors for coronary artery disease, which is the most common cause of heart attacks.

Diagnosis

If you are experiencing heart-attack symptoms, you’ll probably receive an electrocardiogram (ECG) to measure the electrical activity in your heart and blood tests to measure your troponin levels.

Doctors will also use imaging to locate the tear in your coronary artery and measure its size. These scans may include:

* An angiogram, during which dye is inserted into the arteries to reveal areas of blockage.

* An echocardiogram, which uses sound waves to produce video images of your heart pumping.

* A cardiac computerised tomography (CT) scan and/or a magnetic resonance imaging (MRI) scan to provide more detailed images of the heart if necessary.

Treatment

Treatment will depend on:

* the size and location of the tear

* the symptoms that the patient presents with

* the amount of damage to the heart

The aim of the treatment is to restore full blood flow to your heart. In some cases, this will occur naturally, either without any treatment or with medication alone. Managing your condition this way is safe and it is the preferred option.

Some useful and commonly used medication, may include:

* cholesterol-lowering medication

* blood pressure-lowering agent

* blood-thinning medication

* medication to control chest pain (such as nitro lingual spray).

Not everybody will require medication. The heart specialist will discuss your individual case and treatment plan with you.

Sometimes surgery may be needed to repair the damage. This could include having a stent inserted to open up the artery or coronary artery bypass surgery, in which a grafted vessel lets the blood-flow bypass the blockage.

Recovery

After the patient has been discharged from hospital, there is need to have regular follow-up appointments with the cardiology team to monitor the condition. These appointments are a great opportunity to discuss any concerns or questions that the patient may have.

Spontaneous coronary artery dissection reoccurs in about ten per cent of people who have experienced it once. In rare cases, it may occur on multiple occasions. Subsequent dissections are more likely to occur within the first few months of the first event, with the risk reducing as time goes by.

However, the large majority of people who have experienced the disease go on to live healthy lives without further problems.

Exercise and activity

Some form of regular exercise is important for the ongoing physical and mental health of the patient, but it is a good idea to discuss exercise with your cardiac team.

Moderate aerobic activities such as swimming, cycling and running are usually safe. However, there are some activities which you will need to avoid. These include:

* those that have abrupt starts and stops, eg high-intensity training or sports

* those that cause very quick increases in blood pressure, eg heavy weightlifting

* activities which increase the risk of sudden, rapid, or severe neck motion, eg roller coasters

* activities that maintain the neck in an extended position for a prolonged period of time, eg certain yoga positions

It is important your exercise plan is safe for you, so you will need to discuss it with your nurse or your cardiologist.

Contact Dr Maxwell on 3631807 or 7575411