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Heart Disease 

Spontaneous Coronary Artery Dissection (SCAD)

Definition

Spontaneous coronary artery dissection (SCAD) is a rare but serious condition that results when an inner layer of one of the blood vessels in the heart tears. Blood seeps between the artery layers, forms a blockage and can slow or block blood flow to the heart, causing angina, heart attack, abnormalities in heart rhythm or sudden death. 

Women in their 40s and 50s are most at risk of SCAD, although it can occur at any age and also in men. The majority of people who develop SCAD are often healthy with no known risk factors of heart disease such as high blood pressure, diabetes or high blood cholesterol.

Symptoms

Signs and symptoms of spontaneous coronary artery dissection may vary from mild discomfort in the chest to common heart attack warning signs. If you experience any of the below, it is best to seek medical advice immediately:

  • A rapid heartbeat or fluttery feeling in your chest
  • Chest pain
  • Dizziness
  • Nausea
  • Pain in your arms, shoulders or jaw
  • Shortness of breath
  • Sweating
  • Unusual or extreme tiredness

Causes

Spontaneous coronary artery dissection (SCAD) is a very rare condition and not enough medical research has been done into the disease, so the causes are largely unknown. However it is likely that a combination of factors trigger SCAD. These include:

  • Blood vessel changes
  • Sex hormone changes
  • Blood volume changes
  • Changes in women related to pregnancy or menopause
  • For men and women, extreme exertion and extreme stress appear to play a role
  • Intravascular ultrasound
  • Optical coherence tomography
  • CT scans

Diagnosis 

To diagnose spontaneous coronary artery dissection, your doctor may order the following tests after reviewing your symptoms:

  • Coronary angiogram
  • Intravascular ultrasound
  • Optical coherence tomography
  • CT scans

A major challenge in diagnosing SCAD is getting health care practitioners to see beyond the young, seemingly healthy individual, as they are not stereotypical patients at risk of a heart attack.

Treatment

The goal of treatment for spontaneous coronary artery dissection (SCAD) is to restore blood flow to the heart. Treatment plans will depend on the severity of your condition including the size and location of the tear. Medication may include:

  • Inserting a stent to hold the artery open
  • Surgery to bypass the damaged artery
  • Medications such as aspirin, blood-thinning drugs, blood pressure drugs or medications to control chest pain, cholesterol drugs, beta blockers
  • Cardiac rehabilitation program
  • Checking and monitoring weaknesses in other blood vessels

Prevention

Because there has been very little research into spontaneous coronary artery dissection (SCAD) and the causes are still unknown, there is no scientifically proven way to prevent SCAD from occurring.

It is best to keep your heart healthy and follow advice regarding general heart disease prevention, such as:

  • Regular exercise
  • Eat a healthy diet
  • Not smoking
  • Moderate alcohol consumption
  • Manage stress levels
  • Control blood pressure, blood cholesterol and sugar levels

Research into SCAD

The Victor Chang Institute is leading Australia's first research program into Spontaneous Coronary Artery Dissection (SCAD). Previously SCAD was thought to be a rare disease, but recently it has been found to be the cause of 2-4% of all cases presenting with acute coronary syndrome (ACS) and to account for up to 24% of cases of myocardial infarction (MI) in women aged <50 yr, is spontaneous coronary artery dissection (SCAD). 

SCAD is a non-atherosclerotic disease of coronary arteries that presents as an ACS or sudden death in younger women (45 – 52 yr), who are not overweight and have a low incidence of traditional risk factors, and can occur in families. It has also recently been strongly associated with fibromuscular dysplasia (FMD) with 45-86% of cases having been found to have non-coronary FMD on routine screening. Given that both conditions are uncommon, this suggests that SCAD and FMD are pathophysiologically linked. Of interest, a genetic association study of FMD in patients of European ancestry recently identified an intronic variant in the phosphatase and actin regulator 1 gene (PHACTR1), involved in angiogenesis and cell migration, with higher PHACTR1 expression in primary cultured fibroblasts of FMD risk allele carriers compared to non-carriers.

At the Victor Chang Institute, we have recently reported on the outcomes of the first 40 of now almost 200 SCAD patients that we have accumulated, including six families with more than one affected, most of whom were accrued as a result of a social media survey. FMD was identified in 7 (37%) of 19 patients screened. Interestingly, migraine was identified in 43% of the 40 cases, a prevalence that is similar to previous reports of SCAD (37.5% cases) and FMD (32.2% cases) and considerably higher than in the general population (12%, P<0.001). Accordingly, we hypothesise that SCAD is due to a genetic susceptibility resulting from variants in the phosphatase and actin regulator 1 gene (PHACTR1), or in genes in functionally related pathways, involved in angiogenesis and cell migration. 

Further, we hypothesise these variants result in a systemic vascular process with both structural endothelial vulnerabilities and impaired vasomotor tone as possible mechanisms for both SCAD and migraine development, which is commonly observed in SCAD suffers, via altered functions of PHACTR1 or pathway-related proteins. Accordingly, we are currently undertaking genetic, genomic and cell biology studies to test these hypotheses in our cohort of SCAD patients. 

Participate in SCAD research 

If you are an Australian SCAD survivor and would like to be involved in the Australian first research program at the Victor Chang Institute, please email: scad@victorchang.edu.au

A Facebook group has been set up especially for Australian SCAD survivors. It's a great support network.


Research into SCAD

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