A rare type of heart attack has been labelled “mysterious” and “devastating” — and it targets young, healthy women.
Spontaneous coronary artery dissection (SCAD) heart attacks happen when there’s a tear in one of the layers of the artery wall.
Dr. Sherryn Rambihar, staff cardiologist at Mackenzie Health and spokesperson for Canada’s Heart and Stroke Foundation, told Global News that while it’s rare, health officials are identifying SCAD more and more.
“It’s not that it has jumped out of nowhere, we’ve always known it’s been present,” she explained. These days, she said, when a patient has a heart attack, they tend to go a catheterization laboratory (or cath lab) to examine their arteries with a dye test, which can determine the type of heart attack the patient has.
“That wasn’t as accessible and available in the past,” she said. “Now we know a number of women were presenting with [SCAD] in the old days where cath wasn’t readily available and they would’ve been dismissed.”
Chest pain, she added, was often dismissed as “normal,” so one of the reasons SCAD is more identifiable now is that technology is able catch it.
“It was always there, we were just never able to see it.”
Symptoms of SCAD, like a heart attack, include chest pain, shortness of breath, sweating or nausea.
A recent report in Medscape added the tear in the artery ultimately blocks blood flow to the heart, causing a heart attack. Rambihar added the tear can be about four centimetres, keeping in mind a coronary artery can be 13 centimetres.
But SCAD is still considered rare. “Although SCAD causes a small percentage of heart attacks overall, it’s responsible for 40 per cent of heart attacks in women under the age of 50. And it mostly happens to women. More than 90 per cent of SCAD patients are female,” Medscape noted.
In 2017, researchers in Alberta added there were at least 350 cases of SCAD in Canada per year and 70 per cent of victims are women.
“This is an important cause of heart attacks among younger people, and it has really only been in the past five or so years that our thinking on it has changed. For the past 100 years, we had been missing it,” Dr. Sharonne N. Hayes, a leading SCAD researcher at the Mayo Clinic, told Medscape.
“SCAD is happening to a group of women who appear healthy, are thin, and have no risk factors. So even though they have classic heart attack symptoms, they are often being misdiagnosed,”
Rambihar said the biggest problem with these cases is the lack of data, but there are some experts out there doing the research.
The Canadian SCAD study has been following women since 2014, and hopes to wrap up its findings in 2020. The study will look at the “natural history of the condition, predisposing medical conditions (that can result in a heart attack), treatment strategies and long-term cardiovascular outcomes,” authors noted.
Rambihar added one of the biggest reasons there is more awareness around SCAD is because women are rallying together online. From Facebook groups to support networks to even sharing their stories with publications and research centres, more women are understanding what SCAD is.
Rambihar said research previously suggested women and men had the same hearts, but that new data now exists to suggest this isn’t the case. A typical heart attack involves clogged arteries or patients with risk factors like diabetes, high cholesterol or high blood pressure. But for SCAD heart attacks, it’s a little harder to figure out the exact cause.
“There are conditions that do cause or predispose people to have problems with their coronary arteries [like] connective tissue problems or things like lupus,” she explained. The most common thing in SCAD is fibromuscular dysplasia, a condition that causes abnormal growth in the arteries — most people wouldn’t even know they have it,” she added.
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She also alludes to emotional stress, physical activity, childbirth, coughing or even cocaine use as some of the factors that can cause SCAD.
“The first-ever description of this condition was in 1931 where a woman vomited and vomited and basically ruptured her coronary artery. She was 42.”
The best thing people can do is to be their own advocates, she added, because SCAD does target healthy people. If you feel chest pain or any other symptoms, check in with your doctor and speak up about SCAD.
“If [you] don’t feel quite right, don’t let anybody send you home from the emergency room without arranging definitive tests.”
On the doctor side of things, she added, healthcare professionals need to also be more aware of SCAD and its literature.
— With files from Su-Ling Goh
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