Spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) is a tear in the coronary arterial wall that is not related to trauma or medical instrumentation. This leads to a reduction or blockage of blood flow to your heart, which causes damage to your heart muscle and affects your heart rhythm. Reduced blood flow could cause a heart attack or cardiac arrest.

SCAD occurs most often in people aged 30 to 50 and affects women more often than men. People who develop SCAD often have no known risk factors for coronary artery disease.

Common symptoms of spontaneous coronary artery dissection include:

• Chest pain, pressure, tightness or heaviness
• Rapid heartbeat, fluttery feeling
• Pain in arms, shoulders, jaw, neck, back or stomach
• Excessive sweating 
• Unusual/extreme exhaustion
• Nausea, vomiting
• Dizziness/lightheadedness
• Fainting/loss of consciousness
• Headache

The cause of spontaneous coronary artery dissection is unknown. It often starts with an artery wall weakening. Causes of weakened artery walls include:

• Fibromuscular dysplasia
• Genetics 
• Multiple pregnancies
• Connective tissue disorders
• Systemic inflammations (like Crohn’s disease)
• Hormonal changes/therapy
• Cocaine use

Learn more about the causes of spontaneous coronary artery dissection.

Your doctor will review your medical history and may order the following tests:

• Electrocardiogram (ECG)
• Coronary angiogram
• Multidetector computed tomography scan (MDCT) to provide a detailed image of your heart

Your doctor may treat your condition with a combination of medication and lifestyle changes. Treatment options will depend on the location and length of your tear and the damage done to your artery, with the hope that your artery will heal itself. SCAD treatment is usually conservative because surgery and aggressive treatments can be high risk.

Your treatment may include:

• Controlling blood pressure 
• Medications, such as beta-blockers, ACE inhibitors and Aspirin
• Cardiac rehabilitation

Sometimes medications and lifestyle changes may not work for you and surgery is needed. This could happen if the tear is too extensive or is near an important part of the heart. If you continue to have symptoms or remain unstable you may also need one of these procedures: 

• Angioplasty/percutaneous coronary intervention (PCI)
• Implanted defibrillator 
• Coronary artery bypass grafting (CABG)

Learn more about treatment options for spontaneous coronary artery dissection.

The following resources have information about the causes, symptoms, diagnosis and treatment for angina:

• Heart and Stroke Foundation: Spontaneous coronary artery dissection
• University of British Columbia Faculty of Medicine: Spontaneous coronary artery dissection
• University of Ottawa: Spontaneous coronary artery dissection