In many cases of spontaneous coronary artery dissection (SCAD), a heart attack is often the first sign of trouble.

SCAD is an emergency condition that occurs when there is a tear in the artery that can lead to restricted or blocked blood flow to the heart.

The artery has three layers. When a tear occurs, blood can flow through the innermost layer and can become trapped and bulge inward, resulting in restricted or blocked flow to the heart which can cause a heart attack.

Though it can affect both men and women, SCAD tends to be most common among women in their 40s and 50s. People who have SCAD typically don’t have other risk factors for heart disease, such as diabetes, high blood pressure or high cholesterol. Often times, patients with SCAD are otherwise healthy.

According to the American Heart Association, SCAD remains uncommon. Because a heart attack is often the first sign of SCAD, it is important to recognize the signs. Warning signs of a heart attack may include chest pain or pressure, profuse sweating, shortness of breath, dizziness, nausea or pain in your arm, jaw or neck.

Although researchers are not sure what causes SCAD, studies suggest a hormonal link, showing greater incidence in women who are pregnant or who’ve recently had a baby. According to a 2018 scientific statement from the American Heart Association, SCAD is the number one cause of heart attack during pregnancy and in the period right after giving birth.

Studies have also indicated a link between SCAD and fibromuscular dysplasia (FMD), a condition that causes abnormal cell growth in the arteries that can lead to a tear in the artery wall, according to the American Heart Association.

Other research has indicated a link between SCAD and some genetic connective tissue disorders such as Marfan, Ehlers-Danlos or Loeys-Dietz. There are some studies that suggest a link between SCAD and extreme physical or emotional stress, but additional research is needed.

While treatment for some heart attack patients may involve a stent to hold the artery open, for patients with SCAD, medication and blood pressure control are often a first course of action. In some cases, surgery may be required. Your doctor may use an angiogram, intravascular ultrasound or optical coherence tomography screening, to make a diagnosis.

SCAD patients should make sure to advise their doctor of any changes in health. The American Heart Association also recommends keeping blood pressure in check, quitting smoking and lowering your cholesterol to reduce heart disease risk.

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