When It’s More Than a Heart Attack

Severe heartburn and traditional heart attack symptoms – such as chest pains and shortness of breath – could be another dangerous condition, especially if you’re a woman in your 30s or 40s.

It’s very rare, but spontaneous coronary artery dissection (SCAD) is a potentially fatal emergency condition that occurs when a tear forms suddenly in the inner lining of the arteries that supply blood to the heart.

When the tear, or tears, occur, blood seeps into the walls of the artery. This causes the wall to bulge, narrowing or completely blocking blood flow through the artery, resulting in chest pain or a heart attack.

It can happen to people of any age, though the vast majority of patients are otherwise healthy women between the ages of 30 and 50. And while researchers have pinpointed a handful of risk factors, the cause of SCAD remains a mystery.

SCAD Symptoms

For many people, the first symptom is a heart attack. But if the affected coronary artery isn’t completely blocked, SCAD may initially feel like a severe case of heartburn. It may also mimic symptoms associated with heart attacks. These include:

• Chest pain
• Rapid heartbeat or fluttery feeling in the chest
• Pain in the arms, shoulders, back or jaw
• Shortness of breath
• Sweating
• Unusual, extreme tiredness
• Nausea
• Dizziness

SCAD Risk Factors

While researchers have yet to determine a definitive cause for SCAD, they have identified numerous risk factors shared by patients. They include:

• Gender: SCAD occurs in both men and women, but tends to affect women more often. One study of 440 cases between 1931 and 2008 found that 98 percent were women.
• Childbirth: Some women with SCAD recently gave birth, with the condition hitting most often in the first few weeks after delivery.
• Fibromuscular dysplasia (FMD):  This condition causes irregular growth of cells in the arteries. It can lead to weak artery walls, blockages, dissections and aneurysms. Women are more likely to have FMD than men.
• Hormone use: Oral contraceptives, infertility treatments and other hormone therapies have been associated with SCAD.
• Inflammation: Diseases, including lupus, which cause inflammation in blood vessels have been linked with the condition.
• Inherited connective tissue diseases: Genetic diseases, including vascular Ehlers-Danlos syndrome and Marfan syndrome, have been found in people who have had SCAD.
• Severe high blood pressure
• Illegal drug use

Diagnosis

Diagnosis starts like most other complaints of chest discomfort and shortness of breath. Your doctor will likely use an echocardiogram to measure heart activity. And a blood test may be used to look for elevated levels of troponin, a protein released into the blood following damage to the heart. Other tests include:

• Coronary angiogram: A special dye is injected into the arteries to make them show up on imaging tests. X-rays can confirm the location and size of SCAD.
• Intravascular ultrasound: A special imaging catheter is used to create images of the arteries through sound waves. This is sometimes done in addition to the coronary angiogram, for SCAD confirmation and to develop a treatment plan.
• Optical coherence tomography: This procedure uses a catheter that creates light-based images of the arteries. This test may follow a coronary angiogram.
• Cardiac computerized tomography (CT) angiography: This test creates images of the heart and chest by using a computer to assemble X-ray images from multiple angles.

Treatment and Outlook

The goal of treatment is to restore blood flow to the heart, alleviate chest pains and prevent a recurrence of the condition. These objectives can be accomplished through a variety of treatments and medications. Initial treatments often are based on the size and location of the tear. In some instances, a series of smaller tears may be managed primarily through rest and medications. Among the treatments:

• Stent: If medications fail to alleviate chest pain, your doctor may recommend placing a small mesh tube (stent) inside the artery to keep it open. Your doctor, using X-rays for guidance, positions the stent using a long, thin tube inserted through an artery in your arm or leg.
• Surgery: If other treatments haven’t helped, or if there are multiple tears, your doctor may suggest surgery to restore blood flow. Coronary bypass surgery uses a blood vessel from another part of your body to create a new pathway for blood flow.
• Medication: A variety of medications – including anti-platelet therapy with agents like Aspirin, blood thinners like Heparin, cholesterol lowering agents including statins and blood pressure medications – may be used to control risk factors that may have contributed to the condition.
• Lifestyle: Your doctor may suggest other changes to avoid a recurrence. Illicit drug use should be stopped. And if pregnancy was suspected as a contributing cause, further pregnancies may be discouraged.