What’s overlooked can be fatal

Spontaneous coronary artery dissection is far more common than was previously thought, and patients may benefit most from conservative treatment.

Most spontaneous coronary artery dissection (SCAD) patients are generally healthy, and have few conventional cardiovascular risk factors, such as high blood pressure, unhealthy cholesterol levels, and smoking.

The condition occurs when a tear forms in one of the blood vessels in the heart. The tear separates the inner layer of the artery wall from the outer layer, creating a flap that can slow or block blood flow to the heart, potentially causing heart attack, cardiac arrest or, in some cases, sudden death.

hand holding a pen drawing a heart icon

While SCAD is responsible for a small percentage (about 1 to 4 percent) of all heart attacks, it is the cause of about one-third of heart attacks in women younger than 50. And, it’s the leading cause of pregnancy-associated heart attacks.

Yet, until recently, little was understood about SCAD. For years, the condition was described as a rare and almost universally fatal cause of acute coronary syndrome, heart attack, and sudden cardiac arrest in women during and shortly after pregnancy. As a result, SCAD was often under diagnosed or, in some cases, managed as atherosclerosis—an approach that could potentially cause more harm for the patients.

In February 2018, the American Heart Association published a new scientific statement on SCAD in its journal Circulation. The statement revealed that SCAD is not only far more common than was previously thought, but that SCAD patients may benefit most from conservative treatment that allows the body to heal on its own. Treating a SCAD patient with a stent—one of the most important initial steps in treating a heart attack caused by atherosclerosis—can make the dissection worse, says Jennifer Lewey, director of the Women’s Cardiovascular Center and co-director of the Pregnancy and Heart Disease Program at Penn Medicine.

“If you try to put a stent in, it can cause the hematoma to spread in the vessel,” Lewey says. “Some patients will need a stent or bypass surgery, but that’s the exception—in most cases, the dissection will heal within weeks to months with medication alone.”

While Lewey advises against strenuous exercise, she encourages patients to participate in cardiac rehabilitation. Rehab programs often include monitored exercise, nutritional counseling, emotional support, and education. Staying physically active is important for a patient’s heart health and mental health, Lewey says.

Read more at Penn Medicine News.