Spontaneous coronary artery dissection

What is spontaneous coronary artery dissection (SCAD)?

Your coronary arteries are made up of three layers. SCAD happens when one or more of the inner layers of a coronary artery tears away from the outer layer.

Blood is able to flow into the space between the layers and a blood clot forms, reducing the flow of blood through the artery.

This can lead to a heart attack, as the blood supply to your heart has been blocked. Or a cardiac arrest.

SCAD is a rare heart condition that happens suddenly with no apparent warning. It is most common in women who are in their 40’s and 50’s, but can happen to anyone. The condition can’t currently be predicted or prevented.

Most people who have SCAD do not have usual risk factors for heart disease such as high cholesterol, smoking or diabetes. These are often the risk factors which can increase your chance of having a heart attack. This means that SCAD can be misdiagnosed or there may be a delay in diagnosis.

People with no risk factors often ignore symptoms, as they don’t think they’d be at risk of a heart attack. But it’s important to get checked out if you get any SCAD symptoms, so it can be diagnosed as early as possible. 

• Watch our video on the difference between a heart attack and a cardiac arrest

What are the symptoms of SCAD?

The symptoms are very similar to those of angina (chest pain or discomfort) or a heart attack.

They may include: 

• chest pain 
• tightness or pain in the arms, neck, jaw, back or stomach 
• feeling dizzy or lightheaded 
• feeling tired or out of breath
• nausea 
• feeling sweaty or clammy. 

If you have chest pain or any of the symptoms above, call 999 immediately.

What causes SCAD?

Unfortunately we do not yet know a great deal about SCAD, or why it happens. It often strikes out of the blue, but unlike many cases of coronary heart disease (CHD), the condition doesn’t appear to be preventable.

Further research is needed to help us better understand this rare condition.

What we do know is that:

• SCAD most commonly occurs in women between 45 and 53
• many people with SCAD will have few or no traditional risk factors for heart and circulatory disease
• at least 80% of those with SCAD are women
• it can often occur during, or soon after, pregnancy.

How is SCAD diagnosed?

SCAD is diagnosed post event. For example after having a heart attack. Research is currently looking into what the risk factors might be. But as the name ‘spontaneous’ suggests, it is not something that is easy to predict.

The symptoms are the same as for a heart attack, so the condition is usually diagnosed through: 

• having blood tests 
• ECG  
• a coronary angiogram 
• CT scan.

How is SCAD treated?

Treatment for SCAD will vary from person to person depending on their condition and how severe their symptoms are.

Most people will have a coronary angiogram, and following this SCAD may be treated in the following ways:

• with medication to prevent blood clots and reduce blood pressure if necessary (such as blood thinners, aspirin or beta blockers)
• through inserting a stent in the affected artery, if SCAD has blocked the blood flow to your heart muscle
• having coronary artery bypass surgery to restore blood flow (although this is rare).

Cardiac rehabilitation

If you have a heart attack, you are usually referred to a cardiac rehabilitation service for specialist advice, support and physical activity. However, these are not available in all areas.

If you can’t get to cardiac rehab for any reason, we offer a free online programme for you to do at home. Visit our cardiac rehab hub to sign up for our free programme, or watch the videos in your own time. 

Cardiac rehab is a mix of exercising in a safe space, education, relaxation and psychological support. It aims to help you recover and get back to living your life as fully as possible.

You can find out where your nearest cardiac rehabilitation programme is by visiting cardiac-rehabilitation.net.

Heart Helpline and other support

A SCAD diagnosis can be frightening, especially if you’ve found out about it after an emergency. Many SCAD patients experience feelings of isolation due to the rarity of the condition.

Many people tell us they feel anxious, panicky or depressed after diagnosis. This is completely understandable. It’s important to talk about these feelings, either to a trusted loved one, your GP, a cardiac rehab nurse, a clinical psychologist or counsellor.

If you feel more comfortable seeking help online, there are lots of services that can help. With us, you can: 

• Speak to our cardiac nurses by phone, callback, email or online chat on Heart Helpline (Monday to Friday, 9am to 5pm).
• Contact us to talk to our customer care advisors, find your local BHF shop and for any comments, compliments and complaints you may have.
• Sign up to our Heart Matters magazine for online information packed with health and lifestyle advice.

There's also a growing community of SCAD patients in the UK and around the world. They support each other via a variety of social networking websites, including:

• Beat SCAD
• Rare Connect online SCAD community
• SCAD family and friends support group (Facebook group)
• SCAD UK & Ireland survivors group (Facebook group).