Coronary Artery Dissection
A sudden tear in a heart artery that can cause a heart attack
Quick Facts
- Type: Cardiac (coronary artery) emergency
- What it is: Tear in the wall of a heart artery
- Often affects: Younger women, few classic risk factors
- Urgency: Medical emergency — call emergency services
Overview
Coronary artery dissection is a tear that develops in the wall of one of the arteries that supply blood to the heart muscle. When the inner layers of the artery wall separate, blood can collect between the layers and form a bulge that narrows or blocks the channel. This reduces or stops blood flow to part of the heart and can cause a heart attack.
The spontaneous form, known as SCAD (spontaneous coronary artery dissection), happens without warning and is an important cause of heart attacks in people who do not fit the usual picture of heart disease, particularly younger and middle-aged women, including some who are pregnant or have recently given birth. It is a medical emergency. Because it can occur in otherwise healthy people, the symptoms are sometimes not recognized as a heart problem, which makes awareness important.
Symptoms
The symptoms are those of a heart attack and usually come on suddenly.
- Chest pain or pressure, which may spread to the arm, shoulder, neck, jaw, or back
- Shortness of breath
- Sweating
- Nausea
- Unusual tiredness
- A rapid or irregular heartbeat, dizziness, or fainting
These are emergency symptoms. Anyone with chest pain or other signs of a possible heart attack should call emergency services immediately, even if they are young or otherwise healthy and have no known heart problems.
Causes
In many cases of spontaneous coronary artery dissection, the exact cause is not fully understood, but several factors are linked to it.
- Blood vessel conditions: Disorders that weaken artery walls, such as fibromuscular dysplasia.
- Hormonal factors: An association with pregnancy and the weeks after childbirth.
- Physical or emotional stress: Intense exercise or severe emotional stress can sometimes trigger an event.
- Other factors: Certain connective tissue disorders and, less commonly, related medical conditions.
Importantly, SCAD often occurs in people without the traditional risk factors for heart disease, such as high cholesterol or longstanding artery narrowing.
Risk Factors
- Female sex, particularly younger and middle-aged women
- Recent pregnancy or childbirth
- Fibromuscular dysplasia or certain connective tissue disorders
- Extreme physical exertion or intense emotional stress
- A previous coronary artery dissection
Diagnosis
Coronary artery dissection is diagnosed urgently in a hospital, usually during the evaluation of a suspected heart attack.
- Coronary angiography: An imaging test in which dye is injected to view the heart arteries and identify the tear.
- ECG and blood tests: To detect signs of a heart attack.
- Advanced imaging: Specialized intravascular imaging may be used to confirm a dissection that is hard to see on standard angiography.
Treatment
Treatment is individualized and decided by heart specialists, because the best approach for SCAD can differ from that of a typical heart attack caused by cholesterol buildup.
- Conservative (medication-based) care: Many dissections heal on their own over time, so doctors often treat with medications and close monitoring rather than immediate intervention.
- Medications: Such as those to manage blood pressure, heart rate, and chest pain, tailored to the individual.
- Procedures: Stenting or, rarely, bypass surgery may be needed when blood flow is severely compromised or the person is unstable.
- Cardiac rehabilitation and follow-up: Important for recovery and reducing the risk of further events.
Decisions are made by a cardiology team experienced in this condition, since the management strategy is specialized.
Prevention
Because the cause is often unclear, SCAD cannot always be prevented, but some steps may help reduce risk and support recovery.
- Manage blood pressure and follow your cardiologist's advice after an event
- Avoid extreme physical exertion if advised, and discuss safe activity levels
- Be evaluated for related conditions such as fibromuscular dysplasia if recommended
- Seek immediate care for any chest pain rather than dismissing it
When to See a Doctor
Coronary artery dissection is a medical emergency. Call emergency services immediately for chest pain or pressure, especially if it spreads to the arm, neck, jaw, or back, or comes with shortness of breath, sweating, nausea, or fainting. Do not assume you are too young or healthy to have a heart problem, as SCAD often affects people without typical risk factors. Anyone who has had a coronary artery dissection should also seek prompt care for any return of symptoms.
Frequently Asked Questions
What is coronary artery dissection?
It is a tear in the wall of an artery that supplies the heart. Blood can collect between the layers of the artery wall, narrowing or blocking it and reducing blood flow to the heart muscle, which can cause a heart attack. The spontaneous form is called SCAD.
Who gets SCAD?
It is an important cause of heart attacks in people who do not fit the usual profile of heart disease, particularly younger and middle-aged women, including some who are pregnant or recently gave birth. It often occurs without traditional risk factors like high cholesterol.
What are the symptoms?
The symptoms are those of a heart attack: chest pain or pressure that may spread to the arm, jaw, neck, or back, along with shortness of breath, sweating, nausea, or fainting. These require emergency care, even in someone young and otherwise healthy.
How is it treated?
Treatment is individualized by a cardiology team. Many dissections heal on their own, so doctors often use medications and close monitoring rather than immediate procedures. Stenting or surgery may be needed when blood flow is severely reduced or the person is unstable.
Is it an emergency?
Yes. Coronary artery dissection can cause a heart attack and is a medical emergency. Anyone with chest pain or other possible heart attack symptoms should call emergency services immediately, regardless of their age or apparent health.
References
- American Heart Association. Spontaneous Coronary Artery Dissection (SCAD).
- Mayo Clinic. Spontaneous coronary artery dissection (SCAD).
- National Heart, Lung, and Blood Institute (NHLBI).
- MedlinePlus, U.S. National Library of Medicine.