Spontaneous coronary artery dissection (SCAD) is a rare and poorly understood cause of acute coronary syndrome, heart attack, and sudden cardiac death. A spontaneous tear inside one of the layers of a coronary artery creates a flap, or subsequent clot, that blocks blood flow to the heart muscle.

Cardiologists typically have never seen a SCAD, but may remember the term from medical school. Twice online, I’ve communicated with women who’ve been discharged from the hospital after a heart attack with no clear diagnosis. After they’ve returned to their cardiologist and suggested the possibility of SCAD, a review of their angiogram does indeed confirm a dissection. I firmly believe the SCAD diagnosis is missed on a regular basis. SCAD just is not “on the radar” of cardiologists in our ERs.

SCAD was first documented in 1931. The following key points summarize what we know about SCAD today:

  • The vast majority of cases occur in people with no known risk factors or underlying conditions.
  • SCAD is more than twice as common in women than in men.
  • SCAD causes heart attacks and can result in life threatening arrhythmias and sudden death.
  • Pregnancy is a risk factor for SCAD; 30 percent of SCAD cases in women occur near the time of delivery.
  • Seventy percent of SCAD cases occur in people under age 50.
  • The average age when SCAD occurs is 42, but it has been documented in a 19-year-old.
  • SCAD is an emergency and requires urgent treatment.
  • SCAD can recur; up to 10 percent of patients experience two or more events.

With true research underway at Mayo Clinic, now the challenge is finding more SCAD survivors to participate in the virtual registry and DNA biobank. As you encounter stories of unexplained heart attack, please remember spontaneous coronary artery dissection. Your awareness may lead to answers for someone else.

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