Spontaneous Coronary Artery Dissection Causes Sudden Tears in the Heart. Here's What It's Really Like
The rare heart condition can cause heart attacks in otherwise healthy people.
Twice Karen Glugla, a clinical occupational therapy specialist in Michigan, has experienced spontaneous coronary artery dissection.
Known as SCAD, it's a tear within the layers of the heart’s arterial walls that disturbs the flow of blood to the heart, potentially leading to a heart attack or arrhythmia.
That’s exactly what happened to Glugla.
Her first SCAD occurred at home. The mom of four was 41 years old at the time and having an emotionally stressful day. So when she raced up the stairs and couldn’t catch her breath, Glugla thought at first she was experiencing adrenaline or anxiety—after all, she had healthy arteries, low blood pressure, and no risk factors for a heart condition.
“I thought, there’s no way I could be having a heart attack,” Glugla tells Health.
But then the symptoms started mounting: Her left arm felt weird, the pain grew intense, and she was sweating profusely. “The chest pressure got worse, like my chest was caving in,” she says.
At the hospital, she was diagnosed and treated for a heart attack. It would take four years—and another SCAD—for her and her doctors to find out the underlying cause of her heart attack.
Glugla was home for her second SCAD event too. “Maybe I was doing too much,” she recalls. She was just a few days out from an unrelated surgery, and the pain and recovery likely put extra strain on her body.
“I sat on the couch, and it was like an elephant ran across the room and sat on my lap—it was that fast,” Glugla says.
She remembers a strong sense of impending doom. “I thought for sure I wouldn’t be able to make it and say goodbye to everyone.” At the hospital, she was treated for a second heart attack, which is when she heard a doctor say, “This is SCAD.” He looked for and found the tear and was finally able to treat her successfully.
Who's at risk for spontaneous coronary artery dissection?
Luckily, this condition is very rare. “SCAD is not common at all,” Ileana Piña, MD, MPH, Detroit Medical Center’s regional and national director of heart failure, tells Health. “I’ve been doing cardiology for 30 years, and I think I’ve seen just three cases.”
Those cases, she adds, were scary. SCAD is potentially fatal in nature: That arterial tear slows or blocks blood flow to the heart, and the heart attacks or arrhythmias that can result can kill someone, Dr. Piña says.
Men can experience SCAD, but this heart condition is actually most common in women, Dr. Piña adds. Often, like in Glugla’s case, women who have a SCAD will be otherwise healthy without any heart conditions or risk factors.
So what causes it? “We have always associated it with pregnancy post-delivery,” says Dr. Piña, as well as highly stressful situations (think: Glugla’s emotional, stress-filled afternoon, and then later, the physical stress of recovering from surgery).
Be particularly watchful if you experience preeclampsia or gestational diabetes. “I usually call it a failed stress test” when women develop these conditions during pregnancy, says Dr. Piña. The heart isn’t able to keep up with the extra work that accompanies sustaining the placenta and the fetus.
“Those are problems that tell us that endothelial function may not be completely normal, and again, that’s more common in women than men.” (A quick note on endothelial cells: They’re part of the lining of arteries, says Dr. Piña. They perform important functions related to blood flow.)
“Symptoms are very similar to a heart attack,” says Dr. Piña. That’s certainly true for Glugla, who experienced many of these common heart attack symptoms:
SCAD happens quickly, notes Dr. Piña, so seek out emergency care immediately if you have symptoms—even if you do not think of yourself as a likely candidate for a heart attack because of youth or good health.
There aren’t really prevention tactics for SCAD, says Dr. Piña. “I recommend to all women: Know your numbers, know your blood pressure,” she says. And, she says, if you have hypertension, get it treated.
Even if your blood pressure and sugar levels revert to normal after delivering a child, says Dr. Piña, don’t let your guard down. “These women will need to get follow-up [care] for the rest of their lives,” she says.
Diagnosing and treating SCAD
“Since you don’t know what’s going on from an EKG, you need to do a cardiac catheterization and do it pretty quickly,” says Dr. Piña. (This catheter, which is inserted in an artery or vein and runs to your heart, helps cardiologists make a diagnosis.)
Once a tear is recognized, says Dr. Piña, the next step is to repair it, by placing a stent, performing open-heart artery bypass surgery to repair the blood vessels, or sometimes using medications to help the artery repair itself.
Diagnosis often isn’t easy since this condition is so uncommon. “The most important thing is that clinicians need to be able to think about so they don’t miss it,” says Dr. Piña.
Glugla agrees. If cardiologists don’t know what they’re looking for, they won’t recognize SCAD, she says. She mentions that recently, she visited the ER due to chest pains. "Three different doctors that saw me had no idea what SCAD was—so there is still progress to be made!" she says. “I want cardiologists to know if they see a healthy woman coming into the ER with these symptoms, they should run more tests, because they can miss it.”
Still, things are improving. Her cardiologist diagnosed his first case of SCAD in December—a healthy 48-year-old woman with no medical problems. Glugla's doctor told her that "because of me, he now knows what to look for."