Last week I promised to write about an unusual cause of heart attacks in women.
No it’s not leaving the toothpaste uncapped or the empty juice container in the fridge, or even putting the dark clothes in with the whites, it’s SCAD, spontaneous coronary artery dissection.
Overall, this is a rare cause of heart attacks but in women under the age of 50, especially those with none of the traditional risk factors for heart disease, SCAD is the number one culprit causing myocardial infarction. In fact, 30 percent of people who develop a heart attack because of SCAD are women either in the last trimester of pregnancy or new mothers in the first months after they’ve delivered.
This unusual disease can occur in men but at least 80 percent of its victims are women.
What does spontaneous coronary artery dissection mean? The coronary arteries are the blood vessels that carry blood to the heart muscle and serve as the fuel lines that deliver blood with the oxygen and food used by each heart muscle cell to do its work. These blood vessels are about the size of coffee stirrers and divide up like branches on a tree, until each area of heart muscle gets its own blood supply. These arteries are, like all arteries in the body, made of layers of tissue much like tires are made of “belts” of material fused together.
Coronary arteries have three layers; a thin outer wrapper, the adventitia, a thick media, and a thin inner layer called the intima. In SCAD the intima tears and begins to peel away from the media (thus the word “dissection”) causing a flap that flutters in the channel through which blood flows and can actually close off the vessel. Remember, in the “standard” type of heart attack, caused by atherosclerosis or hardening of the arteries, plaque, consisting of calcium, cholesterol and fats, build up in the layers of the vessel wall, narrow the channel, and allow blood to gel in the narrowed, irritated section. Both SCAD and clotted plaque block blood flow to the heart muscle causing it to starve; if not opened quickly, the heart will starve to death, causing a heart attack.
Odd how two different problems, one causing fragile, gossamer tissues to tear, and the other causing tissue to thicken, harden and crack, both lead down the same bad road.
One of the scary characteristics of SCAD is that it occurs in people without the classic risk factors for atherosclerosis like high blood pressure, elevated cholesterol and fat levels in blood, a family history of heart disease, inactivity, smoking, obesity, diabetes and advanced age. Since none of these factors help identify “the usual suspects,” the vague, subtle symptoms that women often experience (as we reviewed last week) can be overlooked by both the victim AND medical professionals.
Ladies, this is exactly why I’m so focused on you realizing that if you think you, or someone you’re in touch with, is having a heart attack, call 911. Remember don’t drive, don’t wait, let us do the tests to separate agita, muscle strain or indigestion from life-threatening heart trouble.
There’s lots of research underway to define the cause of SCAD and the risk factors that may predispose to it. Some “connective tissue diseases” like Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome and pseudoxanthoma elasticum — all of which include a defect in the structure and strength of body tissues, including blood vessels — are associated with SCAD.
Treatment is similar to that for any heart attack and SCAD can’t be proven without cardiac catheterization and although challenging stents can sometimes be the best answer; other times medicines and carefully allowing minor tears to heal is better.
Don’t wait until it’s too late if heart attack symptoms affect either one.
Dr. Alfred Casale is chairman of surgery for the Geisinger Heart Institute, co-director of the Cardiovascular Service Line for the Geisinger Health System and Associate Chief Medical Officer of the Geisinger Health System and Chair of the Geisinger Heart Institute. Readers may write to him via [email protected]