Spontaneous Coronary Artery Dissection
SCAD is a rare, sometimes fatal, traumatic condition with approximately eighty percent of cases affecting women. The coronary artery can suddenly develop a tear, causing blood to flow between the layers which forces them apart, potentially causing a blockage of blood flow through the artery and a resulting heart attack. The condition may be related to female hormone levels, as it is often seen in post-partum women, or in women during or very near menstruation, but not always. It is not uncommon for SCAD to occur in people in good physical shape and with no known prior history of heart related illness. It is also not uncommon for SCAD to occur in people in their 20's, 30's, and 40's, as well as older.
SCAD's have been known to occur during exercise and at rest. SCAD's are usually diagnosed by angiogram and stenting may be necessary to re-open the artery. A dissection can also occur iatrogenically, during the surgical insertion of a catheter into the coronary artery. Treatment depends on the location and severity of the dissection. Coronary Artery Bypass Graft (CABG) surgery may be necessary in some cases. Some cases may be treated with just medication. Incidences of repeat SCADs seem to be rare, but have happened. There may be a connection between certain connective tissue disorders and SCAD. Your doctor may want to perform tests to rule that out.
This is a rare enough condition that most doctors haven't seen it before, which leaves a SCAD patient with many questions that their doctor may not be able to answer or are only guessing at. Your doctor may be learning as much from you regarding this condition as you are from her/him.
All the basics of healthy living become much more important in recovering from this disruptive medical event. Proper nutrition, plenty of rest, stress reduction, realizing your limitations, help and support from loved ones, really listening to your body, and a carefully controlled exercise program are all key factors for healing and recovery.
Recovery from SCAD is different for everyone, but many experience a myriad of new pains and sensations and it can be hard to decipher their cause. Not knowing what is causing these new feelings, and the fear of another heart attack with the last one so fresh in your memory is common. Many report burning or pain in the chest, back, shoulder, and jaw, with or without shortness of breath. Unfortunately, those same feelings may be very similar to the original heart attack. Nitroglycerin may be prescribed for angina. It is important to avoid lifting heavy objects while recovering from SCAD.
The New Normal
A common saying of heart disease patients is “the new normal” which means you have to relearn what is now normal for your body to feel like. Some of the medications, and combinations of medications that SCAD patients are prescribed can have side effects as well, and it may be hard to know whether a symptom is caused by medications, the original dissection, the resulting heart attack, or from the treatments of stents or surgery. Not all medications are right for every patient, and you may have to work with your doctor to get the right combination and dosages that work best for you.
Since not much is known about SCAD in general, not much is known about the kinds of supplements that would be best for this condition either, but it is generally recommended that the normal supplements that are good for your heart and coronary arteries in general would be good for this condition as well. Omega 3 Fish oil supplements and Coenzyme Q10 are both commonly recommended. Talk to your doctor about what would be best for you.
After a period of healing from the initial dissection, which could be several months, but may be different for each patient, a good Cardiac Rehabilitation program is highly recommended to teach you how to properly begin being active again. This will include exercising while being closely monitored by trained staff with cardiac monitoring equipment. SCAD survivors often find that they are the youngest participants in their Cardiac Rehab programs, but that it can be very reassuring to watch their strong steady heartbeat on an EKG monitor while they start to exercise again, as well as having a medical professional right there to answer questions and oversee any problems that may arise. But, just as your doctor may not have experience with SCAD, the Cardiac Rehab staff may not either. Be sure to monitor how you feel as you start exercising and do not push yourself into anything you aren’t ready for. You are not the average heart attack patient.
There are SCAD survivors that have gone on to run marathons. There are SCAD survivors that are in better physical shape now than before their SCAD. SCAD is a life-threatening medical event and the resulting heart attack may cause permanent heart damage. But unlike some other heart diseases, SCAD itself is not a chronically worsening condition. There will be a long period of recovery and you may not be the same as before the heart attack, with possible continuing side effects from it and the treatments for it, but you won't necessarily get worse, and you often get better. With time, care, and proper treatment, it is possible for SCAD survivors to get back to very close to how they felt before if not exactly the same.
The sudden onset of a life-threatening heart attack at a young age, with all the stressful medical procedures commonly associated with that medical event, followed by a period of unexpected debilitation which can completely disrupt ones normal lifestyle and that of their family, makes it not un-common for SCAD survivors to require/seek counseling and/or anti-anxiety medication. This may be especially compounded for post-partum SCAD patients. Post-partum depression is certainly possible after childbirth, but with the additional stress on mind and body that a SCAD and resulting heart attack can bring on top of the stress of childbirth and caring for a young infant, it may be overwhelming. It might be hard for post-partum SCAD patients to focus on their own health with a baby to take care of, but it is in the best interest of both mother and child. Proper amounts of sleep are especially important. Don’t hesitate to ask for help from loved ones, and/or seek professional psychological help if you are struggling and feel you need it.
For women who are accustomed to always taking care of others, it can be hard for them to suddenly be unable to fulfill their normal role as caretaker and be forced to focus predominantly on their own care. Women may find it hard to ask for help when they are usually the one others come to for help. Feelings of guilt are not uncommon, but a caretaker must take care of themselves first to be able to properly care for others. On the bright side, SCAD patients often find out exactly how much they are cared about by loved ones.
As with most other heart diseases, SCAD leaves you looking outwardly normal and others may not understand why you can't do the things you normally do because "you don't look sick". You are doing the best you can, and only you know what you need to get better or just to get by. Try not to push yourself to please others.
Talking to others who have experienced SCAD can help tremendously in understanding your condition and helping you feel less isolated. Since this is not a common problem, talking to others online through support forums is the best way to accomplish this. Comparing symptoms, sharing knowledge, and helping the next person get through it are all ways to be proactive and take control of your recovery.
If you have experienced a SCAD, please take the time to share your experiences on our SCAD Support Forum as well as our SCAD Survey page. More information can be found by searching for SCAD on the WomenHeart Support Community on the Inspire website.