SCAD — A Hidden Heart-Attack Risk for Women Under 50

Cardiologists have highlighted Spontaneous Coronary Artery Dissection (SCAD) as an important and often under-recognised cause of heart attacks in younger women, especially those without conventional cardiovascular risk factors.

What is SCAD?- SCAD is a spontaneous tear or bleeding within the wall of a coronary artery, creating a false channel that compresses the artery and reduces blood flow to the heart.

Why Does SCAD Disproportionately Affect Younger Women?

• Hormonal factors are suspected, particularly pregnancy, postpartum changes and fluctuations in estrogen and progesterone, which may influence blood-vessel structure.
• Pregnancy-associated SCAD is uncommon but can be more severe, with a greater likelihood of involvement of multiple coronary vessels.

How Often is SCAD Missed or Misdiagnosed?

• SCAD is often under-recognised because younger women are not traditionally considered high-risk for heart attacks.
• Symptoms usually resemble a conventional heart attack, with chest discomfort in more than 90% of patients, along with ECG changes and elevated cardiac biomarkers.
• Even coronary angiography can sometimes miss SCAD because the artery may appear long, smooth and narrowed rather than obviously torn.

What are the Strongest Known Triggers or Associations?

• SCAD is associated with fibromuscular dysplasia (FMD), other vascular abnormalities, pregnancy and hormonal changes.
• Possible immediate triggers include extreme physical exertion, heavy lifting or straining, and severe emotional stress.
• Emotional triggers appear more common in women, while physical triggers are relatively more frequent in men.

How to Treat SCAD?

• Treatment differs from that of a conventional heart attack because many SCAD arteries can heal naturally over time.
• If there is no complete blockage or severe ongoing ischemia, doctors may prefer conservative management rather than angioplasty or stenting.
• Beta-blockers may be used to reduce blood pressure and possibly recurrence risk, while statins are not automatically required unless there is another indication.

What is the Risk of Another SCAD?

• SCAD can recur, including several years after the first episode.
• The article notes that recurrence has been reported in roughly 10–30% of patients over longer follow-up, though contemporary cohorts may show lower rates.
• Patients are generally advised to avoid extreme exertion and very heavy lifting, while moderate aerobic activity and resistance exercise are usually encouraged.

Pregnancy After SCAD

• Pregnancy after SCAD requires individualised counselling and specialist assessment.
• Women considering pregnancy should ideally be evaluated jointly by a cardiologist and maternal-fetal medicine specialist because recurrence can occur, particularly in the postpartum period.

SCAD is a distinct and often overlooked cause of heart attack in younger women, and its recognition is crucial because its risk factors, diagnosis and treatment differ significantly from conventional coronary artery disease.