When your artery tears – Spontaneous Coronary Artery Dissection

~ Carolyn Thomas

by Carolyn Thomas  ♥ @HeartSisters

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Laura, a 40-year old American heart attack survivor, told me this story of her own cardiac event:

“I was asleep and my symptoms woke me up. I had several simultaneous symptoms, but the first one seemed to be chest pain in the centre-left, somewhat under my left breast area. I’d never felt anything like it, so sometimes it’s hard to describe – it wasn’t sharp or crushing or burning, more like a dull pressure. I also had pain down the inside of my left arm that radiated up into the left side of my jaw and my left ear.

“I was very overheated, and I felt like I was going to throw up. The nausea and overheating faded, but the pain – chest, arm, jaw – stayed. In hospital, I was diagnosed with a heart attack caused by SCAD – spontaneous coronary artery dissection, treated with six stents.”

It used to be, and sadly remains in almost 70% of cases, a deadly condition often only correctly identified post-mortem during autopsy.  

This brief animation shows what happens during Spontaneous Coronary Artery Dissection – literally a tear in the wall of a coronary artery, or SCAD as we heart sisters know it.

In women, it’s usually the Left Anterior Descending coronary artery involved; in men, it’s typically the Right Main. The tear can either be ‘primary’, occurring spontaneously out of the blue, or ‘secondary’ as a consequence of undergoing coronary angiography, coronary intervention, cardiac surgery or chest trauma.

I like Laura’s simple yet comprehensive explanation of how SCAD usually happens:

“It’s like when the lining of your favorite coat tears, up near the shoulder, and you accidentally put your arm through the space between the torn lining and the outer layer of fabric, but since the sleeve and lining are still sewn together at the wrist, your arm can’t actually come out where it should, at the end of the sleeve.

“Your trapped arm is like the blood in a dissected coronary artery that can’t get to its destination”

Up to 80% of SCAD cases occur in young healthy women. According to a study published online in the Journal of the American College of Cardiology:

“Patients diagnosed with SCAD are characterized by an absence of coronary risk factors, an association with physical or emotional stress, and a high incidence of infarction (heart attack)” .

Spontaneous Coronary Artery Dissection (SCAD) that caused Laura’s heart attack is sometimes referred to as “rare”, but Mayo Clinic cardiologist Dr. Sharonne Hayes now describes this condition as “underdiagnosed” or “infrequent”, especially when discussing heart attacks in younger women. (Mayo Clinic recently saw three SCAD cases in one day, one acute and two as outpatient consultations).

♥   Have you been diagnosed with SCAD?  Find out if you are eligible to participate in two new SCAD studies at Mayo Clinic.

♥ Women in Canada diagnosed with Spontaneous Coronary Artery Dissection SCAD are being recruited for a Canadian study based in seven cities nationwide, led by cardiologist Dr. Jaqueline Saw in Vancouver. Ask your cardiologist about participating in the Canadian SCAD Study.

 

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♥   Learn more:

  • What is SCAD? written by Mayo Clinic cardiologist Dr. Sharonne Hayes
  • WomenHeart online SCAD support community (it’s free to join, and chat with other SCAD survivors from around the world)
  • in this Wall Street Journal article called “When Patients Band Together: Social Media Spurs Mayo Clinic Research”
  • in this very comprehensive article on SCAD from the Netherlands Heart Journal 
  • Read SCAD Ladies Stand Up: Stories of Patient Empowerment, the special report from Inspire.com and the WomenHeart online support community. It features a  number of interesting first-person accounts from SCAD survivors plus an introduction written by cardiologist Dr. Sharonne Hayes (plus even a link to a Heart Sisters article about SCAD listed on the report’s resource page!)
  •  SCAD Research is a non-profit fundraising organization, started by Bob Alico, whose wife Judy died from SCAD. When Bob asked the cardiologist what had caused the SCAD that so quickly took Judy’s life, the doctor said he would probably never know the cause because little was understood about SCAD. In the midst of his grief, Bob decided something needed to be done to find answers. He learned that Dr. Sharonne Hayes had started researching SCAD at Mayo Clinic, and also that finding enough funding for this research was critical. In 2011, SCAD Research was established to help fund promising studies; over $800,000 has been raised so far.
  •  The American Heart Association’s official Scientific Statement on Spontaneous Coronary Artery Dissection: Current State of the Science
  • TV News Reporter Jennifer Donelan Survives Heart Attack at Age 36

 

Published by Carolyn Thomas

29 thoughts on “When your artery tears – Spontaneous Coronary Artery Dissection”

    1. Hello Rob – treatments for SCAD tend to differ from that offered for patients with ‘typical’ heart attack causes (like coronary arteries blocked with plaque). In SCAD, my understanding is that blood-thinners and other medications to manage blood pressure are usually prescribed. I suggest that your wife joins the (free) WomenHeart online SCAD support group at Inspire – many other women in the same boat to share their experiences/ask and answer questions. Best of luck to you and your wife…

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  2. I had 3 stents inserted into my left ascending/descending Artery to my heart. When I was in the cath lab they went to insert a 4th stent and the artery tore. I was put in ICU with a heart pump.Then after 4 days in ICU they put me on the Cardiac floor for 3 days. I believe recently had a stress test and I failed. The Cardiologist strongly recommended a catheterizaton to see if the artery healed so I could get the 4th stent. I did not heal yet. So they decided to wait and give it more time to heal. I feel much better since they cleaned the 99% blockage. I still get pressure in my chest from time to time. I still get out of breath. So what this boils down to is it okay to leave the torn artery in my heart?
    Thank you
    Carol

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    1. Hello Carol – I’m sorry you have been through all of this! I’m not a physician so of course cannot comment specifically on your case, but I can say generally that in some SCAD cases (those with no conventional blockages but with a severe artery tear that caused the original obstructed artery), these artery tears do heal themselves. Only your doctor can advise you about your own case since you now have both of these conditions. Best of luck to you…

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  3. I am 47 years old and was diagnosed with SCAD few days ago. I am confused and scared as well. I was active, worked out in the gym at least 3-4 days a week, and burned about 350-400 calories each visit. If I did not go to the gym, I would take a 2 mile walk around my neighborhood. Also being a teacher in middle school it was quite hectic at school as well. So thoroughly confused.

    The day I went to the hospital started out with me going to the gym, then to Costco (was loading up for Thanksgiving!) When I came home, I had something to eat and then started feeling uneasy. I felt like throwing up, my left arm started hurting and there was a weird dull pain in my chest on the left side below my left breast just like Laura. Did not understand what was happening and related this uneasiness to heartburn/gas.

    I decided to walk around the house and hopefully feel better. I went to the hospital when symptoms prevailed. At the hospital, the EKG was normal, everything looked ok and surprisingly my symptoms had disappeared. But my blood enzyme level was elevated and they kept me for observation.

    After a couple of EKG’s the doctors informed me that the EKG’s were different and there was a possibility of a blockage. After angiogram, it was clear that it was SCAD – in two places- the LAD and D1. I stayed in the hospital for 4 days, am home now and taking Norvasc, aspirin, Cozaar and Brilinta.

    It has been just few days, I am feeling ok but I get tired easily. My Fitbit shows high heart rate even with slightest activity and I am really concerned as of now. Will meet with my cardiologist next week for a follow -up and will keep posting what happens next.
    Thanks!

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    1. This must be a huge shock to you, Priya – especially given your age and healthy lifestyle (as you know by now, these factors are shared by most SCAD patients). You are in very early days yet, and it will take some time to get your brain wrapped around what has just happened to you. Do not be in a rush to return to “normal”, even though that’s likely exactly what you most wish for right now! Your only job is to rest and help yourself heal as much as possible, while becoming the world expert in your diagnosis. If you haven’t already discovered it, please visit the WomenHeart online SCAD community where you’ll find other women like you in the same boat. It’s free to join, share your story, ask questions, etc. Best of luck to you at your follow up appointment with your cardiologist…

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  4. I am a 58 year old woman, and had a heart attack three weeks ago, diagnosed as SCAD. I came home from work on Monday, and had some breathlessness, and after eating, some heartburn. I thought that the heartburn was because of bad food. I’d had asthma when I was younger, and the breathlessness really felt like mild asthma. I was also very tired, which I thought was because of asthma. I worked for Tuesday and Wednesday, and made an appointment with my primary care provider for Thursday.

    Yes, I should have gone sooner, but I could not believe that I would have a heart attack. I was active, healthy, a nonsmoker, good blood pressure, exercised, no personal or family history of heart trouble. My parents are in their eighties, and have never had strokes or heart attacks.

    My doctor did an EKG, a breathing test, and tested for levels of oxygen in my blood. The tests came out normal; nothing suggested that I had had, or was having a heart attack. She took some blood for testing, and I went home.

    That evening around 7:30, my doctor’s associate called me, telling me that my troponin level was elevated, suggesting that I was having a heart attack. She insisted that I call 911 and go to the hospital, which I did.

    At the hospital, they took me to the cath lab, and diagnosed SCAD. The blockage was in a small branch of an artery. The cardiologist felt that trying to put a stent in or fix it surgically would probably kill me, and prescribed medication and rest.

    I was discharged from the hospital after two days and have been resting at home. The symptoms are easing, and the cardiologist says I have good heart function.

    This just seems so unreal. I was healthy, not all that old, took care of myself…. I have so many friends my age who are overweight and don’t exercise. When we went anywhere, I always had to stop with them because they’d be out of breath from walking a few yards.

    How is it that I had a heart attack — and no way of preventing another heart attack? I loved my garden. Am I going to be able to maintain it? I loved travel — am I going to be able to travel again? I just cannot believe this!

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    1. Lynn, first of all, I am so sorry that this has happened to you. You are in very early days yet; no wonder you are feeling blindsided by this heart attack. If you haven’t done so already, please consider joining the WomenHeart online support community for SCAD survivors. It’s free, and you can share questions or concerns, 24/7. You’ll find lots of women there in the same boat – who were just as shocked and overwhelmed as you are feeling right now!

      I believe that the medical profession seriously underestimates the emotional and psychological toll that a medical crisis like a heart attack can take. That sense of what’s called hypervigilance you describe is actually very common, as I wrote about here.

      I can’t answer your specific questions about your garden or travel – but I can tell you that many SCAD patients happily return to the activities they’ve always loved doing before! Here’s one more thing that might help get you through these early days: run don’t walk to find a copy of the terrific book called Thriving With Heart Disease by cardiac psychologist Dr. Wayne Sotile! I frequently quote him on this site, including in this 4-part series on the 4 stages of heart attack recovery that you might find helpful.

      Best of luck to you, Lynn.

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  5. Hi I am 50 years old today but my story starts 8 years ago.

    I was 42 and had a primary SCAD in my left arteries. I had a very typical heart attack and was treated with the typical treatments. Stents, angioplasty and angiograms etc. The problem was every time they did a procedure, I would suffer a secondary SCAD. I was a first in many ways for the cardiologist and the plan for my treatment was a mystery. I suffered numerous myocardial infarctions (MI = heart attacks), too many to remember.

    I finally stabilized with some wonderful meds and continued on life in a cardio rehab program. Five years later I suffered again a primary SCAD that resulted in again a typical heart attack. This time around the SCAD was on the right side and they tried fixing the problem with invasive procedures only to cause more tears and again numerous MIs. However I also suffered a while blood cell condition and had to be treated for this condition also.

    The team of cardiologist finally decided to treat me with a very high end medication and after a number of days, things settled down once again. I left the ICU after 19 days.

    I wish that the story ends there, but no. I suffered again a SCAD one year ago. This time we made it very clear that no invasive treatment was to be given and a miracle happened. The MI settled down with meds again and I was only in the ICU for 2 days before heading home. Life continues with this condition which no one can explain and to which I get no answers.

    I have had more than 10 MIs in eight years, 7 stents in both left and right arteries and I take a wonderful cocktail of meds twice a day. I was a healthy 42 year old wife and mom of three boys, and continue to be as healthy as this condition lets me be. No history in my family ever of any heart conditions. I have had some genetic testing but it has never produced any answers.

    I continue to amaze and confuse the wonderful team of cardiologists but I don’t mind if I can help them with any kind of experience to save another person.

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    1. Holey Moley, Joanne … What a story! Your amazing journey illustrates an unusual reality of SCAD – the best treatment strategy for acute SCAD remains undetermined. For some, it’s an invasive intervention (which as you learned, can bring its own risk of further damage) and for others, conservative treatment with medications only is what works. Mayo Clinic cardiologists recommend: “Whenever possible, doctors allow the damaged artery to heal on its own, rather than repairing it through invasive procedures.” If you haven’t already discovered it, please visit the WomenHeart online SCAD community – I know women there would appreciate hearing your story, too. Best of luck to you…

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  6. Hi, I am 40 years old, I have Sprintzens also known as DiGeorge syndrome, chromosome 22q11 deletion. I have a metal mitral valve and am on my 3rd pacemaker. I also have speech defects. Two years ago I went into hospital for my 3rd pacemaker change. I was admitted the night before the op. That night I had a crushing in my chest and couldn’t breath. Pain in both arms and tingling. I recovered initially after doctors treated me, went for an angiogram the next morning as it was in the middle of the night. I remember going to the cath lab where they put the dye in – and woke up three days later in Intensive Care. My arteries are oval, two joined, split and bled. I was diagnosed with dissection of the Left Anterior Descending artery. I had three stents which caused restenosis, had bypass surgery. I am not 100% but a hell of a lot better. Just wanted to share my story.
    Sara Twycross

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  7. I was diagnosed with heart failure with ejection fraction of 30%. My doctor found out after angiogram that my arteries are dissecting. I was told that it’s no good for intervention. My doctor told me that taking medication is the best option. So I ask …If meds don’t work..what happens..?

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    1. Hello Janet – I’m not a physician so can’t comment specifically on your case because every person’s experience is so different. I can tell you in general that some patients do benefit from cardiac interventions when appropriate, and some are prescribed medications only – but generally, most doctors prefer to allow the damaged artery to heal on its own rather than repairing it through invasive procedures whenever possible. Again, it depends on the individual. Please go back to your doctor and don’t leave the office until all of your own questions are answered about your personal circumstances. Best of luck to you…

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  8. I am 50 years old and about 4 months ago I had a SCAD heart attack. I then had an angio and found out that the bottom half of my LAD had torn completely length ways. I was put on all the typical heart attack meds to “rest” my heart so the artery could heal.

    It has now been 4 months and I just completed a pharmaceutical stress test, however the results are not good. The results indicate the tear is not healing therefore I am having another angio. My question is what will happen now? Arterial bypass? I was originally told a stent would not work to fix the artery because the tear was too long…it would just flop. Just wondering what the next step would be. I am scared and very disheartened… I had been praying for great results!!

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    1. Oh, dear. That was disappointing news indeed, Ellen. It’s so hard to predict “what will happen now”. I’m not a physician so cannot comment on your specific case, but I can tell you that many of my readers who are SCAD survivors like you have found that the WomenHeart online community is very helpful when you’re looking for information or support on SCAD, so check them out if you haven’t done so already.

      Meanwhile, meet with your physician to carefully review your situation – including all procedures and potential outcomes. Bring along a written list of your questions to your doctor’s appointment. You’re in the very worst of it right now – not knowing is THE WORST! But the more you learn, the less frightening this will feel. Best of luck to you…

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  9. I had an appointment with my Cardiologist 2 days ago and I took him readings from my Blood pressure and my heart rate for two weeks prior to the appointment. (Some readings 203/90, 186/80, 195/90, 198/95, all taken Fri. 13, 2014). I WAS IN THE HOSPITAL 5 WEEKS AGO FOR SEVERAL DAYS WITH HIGH BLOOD PRESSURE THEN. He increased my Blood Pressure med. again but I felt he shrugged off the possibility of SCAD, saying he was not familiar with SCAD. My doctor has me scheduled for an ECHOCARDIOGRAM in two weeks after I take this extra BP med & see what it does and after that I am scheduled for a Nuclear Stress the next week. I am scared and don’t know where to turn. Do you have any advice for a very suspicious patient?

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    1. Hi Beth – I’m not a physician so of course cannot offer you advice on your specific case. However, I can tell you that generally SCAD patients have few if any of the typical risk factors associated with other causes of heart attack such as high blood pressure. Sounds like your docs have organized further diagnostic testing, which is good. Meanwhile, I hope that your new meds are helping address your BP numbers.

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    1. Hello Annette and welcome to the very exclusive club that nobody ever wants to join. You are in very early days yet so no wonder you are feeling conflicting emotions. If you haven’t done so already, please visit the WomenHeart online community of SCAD patients – it’s free to become a member and you’ll find many other women just like you there.

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  11. My 14 year old daughter suffered a heart attack on March 20, 2012 that was caused by SCAD. I’m from a big city and the doctors had never heard of this happening to a young child. I’m trying to gain enough information about SCAD for my daughter. I thank GOD that he saved my daughter and you as well. I really enjoyed this website.

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    1. Lashalle, what a nightmare! And at such a young age – no wonder your doctors had never encountered a case like this. I hope your daughter is doing much better day by day as you and your family try to make sense out of a diagnosis that makes no sense to us! Good luck to all of you.

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  12. Thanks again to my heart-sister Carolyn for covering this story.

    I cringed when another friend referred to my “15 minutes of fame.” I quickly corrected her. This isn’t *my*15 minutes of fame, it’s SCAD’s 15 minutes of fame.

    For every woman out there who’s scared, newly diagnosed, just out of the hospital, and told that what happened to her was rare and we don’t know anything about it, all of this publicity and research is hopefully leading toward the point sometime in the future where cardiologists won’t shrug and say “We have no idea” when confronted with a SCAD.

    There’s a vibrant, active group of us SCAD survivors on WomenHeart’s online message forum, here; please join us.

    For as we’ve seen, when we come together for a common goal, we can do it!

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    1. Thanks Laura for this link to the WomenHeart forum. I think the specific topic you started there about SCAD, however, is an absolute goldmine for SCAD survivors and their physicians.

      In fact, after hearing about SCAD experiences for the past few years from you and other survivors, I was almost surprised to learn how “rare” the diagnosis is considered. It may well be rare to physicians who rarely recognize it when (young, healthy) women show up in the E.R., but to those of us who share stories with other heart patients every day like this, we can feel like it’s tragically common.

      Your efforts with Katherine to spur this Mayo Clinic SCAD research is such a great example of what women can do when they put their mind to it.

      I hope every single SCAD survivor will contact Mayo Clinic to participate in this study.

      Cheers,
      C.

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  13. I’d barely heard of SCAD until I read about it here – and yet this week it seems I’ve heard the Mayo Clinic SCAD research project talked about everywhere! It’s about time that more attention and awareness was raised about this deadly and predominantly female diagnosis. Thank you very much for this.

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  14. Just found this article while trying to learn more of the new Mayo Clinic research on SCAD. This is such an impressive website for women heart patients (and men, too!!!) I can’t believe how much really good stuff you have here, told as only an actual heart attack survivor can tell it. Easy to read, well-written, evidence references, just great stuff! Please keep up the good work – I’m a brand new subscriber now.
    Lisee in Montreal

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  15. Nobody in our whole family had ever even heard of this condition until my twin sister age 42 was hospitalized for a heart attack caused by SCAD. Our mid-sized hospital had never actually seen this in a living patient – usually diagnosed on autopsy, they said. She is very lucky to have survived, as I’m learning from your wonderful website and the very few other resources that even mention SCAD.

    THANK YOU THANK YOU for this and for the link to the SCAD website.
    With gratitude,
    Kim

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  16. My sister is in hospital right now after a heart attack diagnosed with SCAD. Your post here is perfect timing. Our whole family is reeling from this she is only 35 too young for heart attack. Thx VERY MUCH for this.

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    1. Best wishes for your sister’s full recovery. I wish you all much strength and courage.

      I experienced SCAD three years ago (45). SOOO scary! The LAD artery continued to dissect, so I had three “events” in the stretch of a little over a week…I now have 7 stents.

      I wasn’t feeling very powerful after that, but the thing that made me feel powerful was to learn all I could about this. I feel so fortunate that I have been given a second “birthday” to celebrate!

      Stay strong!

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