When you ask people what they think is the number one cause of death for women, heart disease is not always their first guess. And when asked to name a leading cause of heart attacks for women under 50, you don’t often hear mention of a lesser-known condition called Spontaneous Coronary Artery Dissection, or SCAD.  

However, SCAD is more common in women and people assigned female at birth (AFAB) than in men, and it is the number one cause of heart attacks during pregnancy and early postpartum. It can happen at any age, but most commonly affects women in their 40s and 50s. 

Each February, we honor American Heart Month to raise awareness about heart health. As part of this effort, we spoke with Dr. Lidija McGrath, cardiologist at the Center for Women’s Health, to learn more about SCAD and how it can look different than other heart issues. 

What is SCAD?

SCAD is an emergency condition where a tear develops in a wall of a blood vessel that supplies blood to the heart. Blood can collect in the walls of the torn artery, forming a blood clot. This puts pressure on the artery, which becomes smaller as the pressure in the walls builds up. Blood flow to the heart can then slow down or stop, causing a heart attack. 

“Something that is unique about SCAD is that it often affects people who do not have typical risk factors for heart disease, such as high blood pressure or diabetes,” says Dr. McGrath. “It can affect young people or women who have just given birth. It is important not to ignore symptoms such as persistent, severe chest pain or a tearing, burning sensation in the chest, even if you are otherwise healthy.” 

What causes SCAD?

Experts don’t know for certain what causes SCAD, but they think there may be several factors. These can include: 

• Severe stress – either emotional or physical, such as weightlifting 
• Pregnancy and childbirth – of the SCAD cases during pregnancy or postpartum, it occurs most often in the first few weeks after delivery 
• Hormonal changes and hormone therapy – SCAD is more likely to occur in those using oral contraceptives, estrogen, progesterone, testosterone, or corticosteroids  
• Some conditions, such as fibromuscular dysplasia (FMD), Marfan syndrome, Loeys-Dietz syndrome and vascular Ehlers-Danlos syndrome. 
• Drug use – Cocaine and amphetamines may increase the risk of SCAD 

“We know that overall heart health may not play as big of a role in cases of SCAD, and that about half of the cases have some form of stressor before the event” says Dr. McGrath. “This may include intense exercise, particularly with breath-holding or bearing down during heavy lifting, emotional stress, labor and delivery or drug use”. It is also important to note that about 2 out of 10 cases have no known cause or warning signs.  

What are the symptoms of SCAD?

Most commonly, people who experience SCAD have severe, persistent chest discomfort that can sometimes feel like pressure, tearing, ripping or burning. The pain can be in the neck, jaw or arm. Other symptoms may include the following:   

• Excessive sweating 
• Shortness of breath 
• Nausea or upset stomach 
• Dizziness or fainting 

Seek care immediately if you have symptoms of a heart attack, even if you don’t think you are at risk. 

How is SCAD treated?

SCAD can be a challenging diagnosis, and doctors may need to run different tests to confirm it. While patients with a typical heart attack often have certain procedures or surgeries to help manage their heart health, SCAD treatment often takes a different approach. Patients may have better results with medications rather than invasive procedures. Looking for an underlying condition is also often recommended. However, despite medical therapy and lifestyle modifications, SCAD can reoccur in 1-2 in 10 people. 

“Typical lifestyle recommendations for heart disease can help with healing,” says Dr. McGrath, “Everyone who has experienced SCAD should participate in cardiac rehab to learn ways of exercising safely, avoid very heavy lifting and high intensity exercise, and follow their doctor’s recommendations for medications to use or avoid.” 

Dr. McGrath adds, “Patients can also benefit from eating a heart-healthy diet, making sure their blood pressure is well-controlled, and doing regular, low-moderate intensity physical activity after completing cardiac rehab.”