Person with Hypertension: Higher Risk of SCAD

Epidemiological studies have established a strong association between hypertension and CAD. Hypertension is a major independent risk factor for the development of CAD, stroke, and renal failure.

What Is Spontaneous Coronary Artery Dissection (SCAD)?

The job of your coronary artery -- one of the main blood vessels in your heart -- is to bring blood that's rich in oxygen to your heart muscle. In very rare cases, the insides of this blood vessel can shred or tear, and that can cause a dangerous problem. When this happens, it's called spontaneous coronary artery dissection (SCAD). This is an emergency health situation that can cause a heart attack. So it's very important to get medical care quickly.

Symptoms

You may not know there's something wrong with your blood vessel until you have a heart attack. This is often the first sign of SCAD. So signs of this problem are often like those of a heart attack and can include:

Chest pain
A quick heartbeat
Shortness of breath
Feeling very tired
Sweating
Dizziness
Feeling sick to your stomach
Pain in your arm, shoulder, or jaw

If you have any of these symptoms or think you're having a heart attack, call 911 right away. Never drive yourself to the hospital when you have chest pain.

Who Is at Risk

SCAD mainly affects young, healthy women who aren't typically at risk for heart disease. This problem can happen to men, too, but it's much more common in women. You may be at greater risk for SCAD if you:

Have given birth not long ago
Often do very intense exercise
Have very high blood pressure
Have problems with your blood vessels (like fibromuscular dysplasia)
Have an inflammatory condition (like lupus)
Are under serious stress after something like the sudden death of a loved one
Have a genetic disease that affects your connective tissues, like Marfan syndrome
Regularly do illegal drugs, like cocaine

How It Happens

When the inner layers of the wall of your coronary artery begin to buckle or tear, the blood that's moving through it gets caught in pockets made by the damage. This causes the blood vessel to bulge and clog, which makes it hard for blood to pass through. If only a small amount of blood can squeeze through the blood vessel, you may feel serious chest pain. If no blood can pass through to your heart, SCAD can cause a heart attack. Doctors don't know why the insides of the blood vessels begin to tear or shred this way in some people.

Treatment

If you're being treated for SCAD, it's likely that you've just had a heart attack. The goal is to get blood pumping to your heart again and to let your torn blood vessel heal. Drugs: Once blood is flowing to your heart, your doctor probably will want to let your damaged blood vessel heal on its own. To help this along, they may give you one or more medications, such as:

Aspirin or other blood thinners to prevent clots
Medicine to keep you blood pressure stable
Drugs to relieve chest pain
Medication to lower your cholesterol levels

Stent: To get your coronary artery blood vessel to stay open (and unblocked) and let blood flow through freely, your doctor may put a stent inside the blood vessel. This is a tiny tube made of wire mesh that's put in through an artery in your leg. They'll thread the stent through your blood vessel until it's in the right place. Then they'll put a limp balloon inside the stent the same way. They'll blow up the balloon with air, and that will force the stent to open. Your doctor will take the balloon out but leave the stent to hold your blood vessel open.

Surgery: In some cases, your doctor might recommend open-heart surgery. They may need to go around the tear in your coronary artery blood vessel and make a new path for blood to reach your heart. To do this, they may take a section of a blood vessel from your leg and put it in your chest. You'll need several weeks to recover from open-heart surgery. No matter which treatment you have, SCAD can happen again. There's no way to predict who may have a second tear in this blood vessel and who won't. You'll probably see your doctor for regular visits to watch for any signs that it might happen again.