Spontaneous Coronary Artery Dissection: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

A fatal condition known as spontaneous coronary artery dissection arises from a rupture in the heart artery wall. Coronary artery dissection that occurs spontaneously is referred to as "SCAD". By reducing or stopping blood flow to the heart, SCAD might result in a heart attack, an irregular pulse, or abrupt death.

All ages are affected by SCAD, although women in their forties and fifties are the most likely to have it. Patients with SCAD often do not have heart disease risk factors, such as diabetes, high blood pressure, or high cholesterol.

If SCAD treatment is delayed, it may be fatal. If you're having signs of a heart attack, get medical help right away, even if you don't think you're in danger.

Causes Of Spontaneous Coronary Artery Dissection

It is unknown what causes spontaneous coronary artery dissection.

Symptoms Of Spontaneous Coronary Artery Dissection

 Symptoms of SCAD include:

• Chest discomfort or pressure.
• Pain in the arm, shoulder, back, or jaw.
• Breathing problems.
• Sweating 
• Exhaustion 
• Stomach pain
• A fluttering sensation in the chest or a speeding heart.
• Dizziness.

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Risk Factors Of Spontaneous Coronary Artery Dissection

SCAD risk factors include:

• Being a woman: Anyone can create SCAD. However, it disproportionately affects women.
• Childbirth: Some SCAD patients have recently given birth. This could be due to hormone swings and blood vessel stress. SCAD has been determined to be most common in the first few weeks after delivery. SCAD, on the other hand, can occur throughout pregnancy.
• A highly stressful circumstance: Excessive stress might cause SCAD. This encompasses both strenuous physical exercise and significant emotional distress.
• Fibromuscular dysplasia(FMD): This condition weakens the body's medium-sized arteries. FMD can induce vascular issues such as aneurysms and dissections. Women are more likely than men to have it.
• Inherited connective tissue disorders: SCAD patients have been shown to have Ehlers-Danlos and Marfan syndromes.
• Extremely high blood pressure: Severe hypertension can raise the risk of SCAD.
• Use of illegal drugs: Cocaine and other illegal drugs may increase the risk of SCAD.

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Diagnosis Of Spontaneous Coronary Artery Dissection

SCAD is usually detected in an emergency room. Your personal and family medical history may be questioned. Tests are performed on your heart.

Diagnostic tests for SCAD are similar to those used to detect a heart attack. They could be as follows:

• Blood tests: Following a heart attack, certain heart proteins gradually leak into the bloodstream. Blood tests can be used to detect these proteins. Other blood tests may also be conducted.
• ECG or EKG is an abbreviation for electrocardiogram: This basic test looks at the electrical activity of the heart. It may indicate how swiftly or slowly the heart beats. Electrodes are sticky patches that are attached to the chest and, in certain situations, the arms and legs. An electrocardiogram (ECG) can determine whether you are having or have had a heart attack.
• Coronary artery angiogram: This examination looks at the arteries of the heart. A catheter is a long, thin, flexible tube inserted by a doctor into a blood vessel, usually in the groin or wrist. It is aimed at the heart. The dye gets to the arteries via the tube. In photographs and video, the dye makes the arteries more visible. Coronary angiography can be used to diagnose SCAD. It might also highlight any twisted arteries.
  • Additional tests may be performed during a coronary angiography to confirm SCAD and plan treatment. These tests include:
• Optical coherence tomography: This test uses light to examine blood arteries and blood vessel walls. The doctor inserts a flexible tube called a catheter into a blood artery and guides it to the heart. The catheter emits a laser beam. The test can help determine what caused a heart attack.
• Intravascular ultrasonography: Sound waves are used to picture the insides of the heart arteries. The doctor inserts a flexible tube called a catheter into a blood artery and guides it to the heart. Sound waves are produced by a device at the tube's end. The reflected sound waves are analyzed by a computer and converted into pictures of the heart arteries.

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Treatment Of Spontaneous Coronary Artery Dissection

The goal of SCAD treatment is to:

• Restore blood flow to the heart.
• Control your chest pain.
• Prevent SCAD from happening again.

Treatment may include medications as well as a procedure or surgery to open the artery and restore blood flow. SCAD can occasionally heal on its own. SCAD treatment is decided by your overall health as well as the size and location of the arterial tear.

Medications

Some SCAD sufferers just utilize drugs to treat their symptoms. If the chest pain or other symptoms persist, more treatments may be required.

Medication for SCAD may include:

• Aspirin: Long-term aspirin use may lower the risk of heart disease following SCAD. Consult your doctor to determine whether daily aspirin treatment is appropriate for you.
• High blood pressure medication: There are several blood pressure drugs available. You may need to take these medications for the rest of your life to lower your risk of developing new SCAD.
• Medication to relieve chest pain: Medication such as nitrates and calcium channel blockers can help reduce chest pain after SCAD.

Surgery

Surgery or a procedure to mend the artery and improve blood flow to the heart is required in some SCAD patients. These are some of the therapies available:

• Stent placement and coronary angioplasty: This treatment may be used if SCAD reduces blood supply to the heart or medicines.
• A doctor inserts a catheter, which is a long, thin, flexible tube, into a blood vessel, usually in the groin or wrist, during the surgery. It is aimed at the heart. To open the artery, a little balloon on the catheter's tip expands. Following that, the doctor will put a small mesh tube known as a stent into the artery. The balloon is no longer inflated. The stent remains in place. This procedure is also known as percutaneous coronary intervention or PCI.
• Bypass surgery for the coronary arteries: This open-heart procedure creates a new pathway for blood to pass around a partially or completely blocked artery. If past SCAD therapies have failed or if you have a lot of tears, it may be employed. The surgeon removes a healthy blood artery from the chest or leg. This healthy vessel is known as a graft. On one end, the graft is sewn to the artery below the blockage. The other end is stitched to the heart. This surgery is often referred to as cardiac bypass surgery, coronary artery bypass grafting, or CABG  pronounced "cabbage."

Cardiovascular Rehabilitation

Following SCAD therapy, you must have regular check-ups with your doctor.

A specific fitness and education program may be suggested. This is referred to as cardiac rehabilitation or cardiac rehab. It was created to help you recover from a major heart condition. The approach typically includes supervised exercise, emotional support, and education on heart-healthy dietary practices.

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Complications Of Spontaneous Coronary Artery Dissection

A heart attack is a possible side effect of SCAD. SCAD decreases or prevents blood flow via an artery. This weakens the heart and raises the likelihood of having a heart attack. SCAD-induced heart attacks are distinct from heart attacks caused by fat, cholesterol, or other chemicals accumulating in and on the artery walls. This is referred to as atherosclerosis.

In some people with SCAD, the inner and outer layers of the artery may break. Blood can collect between these layers. Pressure from pooled blood might aggravate SCAD.

Even with proper treatment, SCAD can reoccur. It could occur shortly following the initial incident or years later. SCAD sufferers may also be at a higher risk of developing other heart problems.

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