What is SCAD?
By Laurence Schubert APAM
SpontaneousCoronary Artery Dissection or SCAD is rare and often misdiagnosed emergencycondition that typically occurs in middle aged, fit and healthy females. DuringSCAD the wall of a coronary artery develops a tear and blood begins to poolbehind the damaged tissue. As the build-up continues, there becomes a decreasedlumen (space) for blood to pass through. The pressure of pooling blood can leadto worsening artery wall damage and can slow the flow of blood to the heart.Blood flow may be completely halted, leading to death of heart cells or heartattack. Almost all patients with SCAD present with a heart attack. Note that aheart attack caused by SCAD is not the same as a heart attack caused by hardeningof the arteries (atherosclerosis).
Spontaneous - This condition occurs very suddenly,with no obvious medical precursors.
Coronary artery - These are the blood vessels thatsupply the heart, without blood flow to the heart the entire body will shutdown.
Dissection - The opening up of something, in thiscase the wall of a blood vessel (coronary artery).
What are the symptoms of SCAD?
- Chest pain
- A rapid heartbeat or fluttering feeling in your chest
- Pain in your arms, shoulders, neck or jaw
- Shortness of breath
- Sweating
- Unusual, extreme fatigue
- Nausea
- Dizziness
What are the causes of SCAD?
There is noclear causes of SCAD, however it is important to note that there is likely tobe either an emotional stress, physical stress or both that leads to SCAD. Astudy by Jacqueline Saw (2017) found that greater than half of SCAD cases hadsignificant emotional stress.
What are the risk factors for SCAD?
- Female gender - SCAD can occur to anyone but is significantly more prevalent in females.
- Recentchildbirth - Hormonal changes that occur during pregnancy are suspected tocause weakening or changes to arterial walls.
- Underlyingblood vessel condition - E.g. Fibromuscular dysplasia (FMD) is anon-atherosclerotic, non-inflammatory disease of the blood vessels that causesabnormal growth within the wall of an artery. FMD can weaken arterywalls, leading to blockages, dissections or aneurysms.
- Inherited connective tissue diseases - e.g. vascularEhlers-Danlos syndrome and Marfan syndrome.
CardiacRehabilitation
CardiacRehabilitation (CR) is an outpatient program designed to educate and exercisepatients typically 2-3 times per week over a 6 week period. Following a heartattack, it is crucial to complete CR due to the positive results of theprogram. Research has shown that CR reduces heart attack re-occurrence, reducedmortality following heart attack and improved quality of life. Sadly,approximately one fifth of females do not complete cardiac rehab followingheart attack. At present time SCAD specific CR is rare and therefore it iscritical the patient is educated on their condition and has an excellentsupport team around them.
Exercise for SCAD patients
Guidelinesprovided by Jacqueline Saw (international cardiologist)
- o plyometric or high intensity exercise.
- Some light isometric exercise may be okay - e.g. wall sit, bridge, shoulder rotations, lunge hold, calf raise hold, body weight squat hold, calf stretch using wall, groin adduction.
Please notethat this is not medical advice and you should speak with your doctor orcardiologist before commencing any exercise.
