Spontaneous coronary artery dissection (SCAD) is a rare but serious emergency condition in which a tear forms in the wall of a coronary artery, creating a false channel that can partially or completely block blood flow to the heart muscle. The tear separates the layers of the arterial wall without the involvement of atherosclerotic plaque, making SCAD distinct from the more common form of heart attack caused by coronary artery disease.
SCAD most commonly affects women in their 40s and 50s, though it can occur at any age and does affect men. Importantly, people who experience SCAD often do not have traditional risk factors for heart disease such as hypertension, high cholesterol, or diabetes. Associated conditions include fibromuscular dysplasia (FMD, a non-inflammatory arterial disease), connective tissue disorders, hormonal factors (it has been reported after childbirth), and intense physical or emotional stress. In some cases no trigger is identified.
SCAD can cause heart attack, life-threatening arrhythmia, and sudden cardiac arrest. Symptoms are similar to a conventional heart attack: chest pain, breathlessness, jaw or arm pain, and sweating. Anyone experiencing these symptoms should call 999 immediately, regardless of apparent low cardiac risk.
Diagnosis is by coronary angiography, often supplemented by intracoronary imaging (OCT or IVUS) to characterise the dissection. Management differs from conventional heart attack: conservative treatment (avoiding PCI where possible, as intervention can worsen SCAD) is preferred unless there is ongoing ischaemia or haemodynamic compromise. Most arteries heal spontaneously over weeks to months. The risk of recurrence is around 10 to 30%, and long-term follow-up including cardiac MRI and FMD screening is recommended. Beta-blockers are typically prescribed to reduce mechanical stress on healing arteries.
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