What is SCAD?
By Laurence Schubert APAM
Spontaneous Coronary Artery Dissection or SCAD is rare and often misdiagnosed emergency condition that typically occurs in middle aged, fit and healthy females. During SCAD the wall of a coronary artery develops a tear and blood begins to pool behind the damaged tissue. As the build-up continues, there becomes a decreased lumen (space) for blood to pass through. The pressure of pooling blood can lead to 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 heart attack. Almost all patients with SCAD present with a heart attack. Note that a heart attack caused by SCAD is not the same as a heart attack caused by hardening of the arteries (atherosclerosis).
Spontaneous - This condition occurs very suddenly, with no obvious medical precursors.
Coronary artery - These are the blood vessels that supply the heart, without blood flow to the heart the entire body will shut down.
Dissection - The opening up of something, in this case 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
- Unusual, extreme fatigue
What are the causes of SCAD?
There is no clear causes of SCAD, however it is important to note that there is likely to be either an emotional stress, physical stress or both that leads to SCAD. A study by Jacqueline Saw (2017) found that greater than half of SCAD cases had significant emotional stress.
What are the risk factors for SCAD?
- Female gender - SCAD can occur to anyone but is significantly more prevalent in females.
- Recent childbirth - Hormonal changes that occur during pregnancy are suspected to cause weakening or changes to arterial walls.
- Underlying blood vessel condition - E.g. Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory disease of the blood vessels that causes abnormal growth within the wall of an artery. FMD can weaken artery walls, leading to blockages, dissections or aneurysms.
- Inherited connective tissue diseases - e.g. vascular Ehlers-Danlos syndrome and Marfan syndrome.
Cardiac Rehabilitation (CR) is an outpatient program designed to educate and exercise patients typically 2-3 times per week over a 6 week period. Following a heart attack, it is crucial to complete CR due to the positive results of the program. Research has shown that CR reduces heart attack re-occurrence, reduced mortality following heart attack and improved quality of life. Sadly, approximately one fifth of females do not complete cardiac rehab following heart attack. At present time SCAD specific CR is rare and therefore it is critical the patient is educated on their condition and has an excellent support team around them.
Exercise for SCAD patients
Guidelines provided by Jacqueline Saw (international cardiologist)
50-70% of HR reserve on the basis of entrance level testing which restricts systolic BP to <130.
Resistance training with 1 - 6kg weights - aim high repetitions instead of heavy weights.
Avoid lifting weights > 9kg.
Perceived exertion should be in the zone of "moderate" to "somewhat difficult".
Avoid isometric (static) exercise. E.g. planks, hanging.
Maintain movement through exercise, do not hold breath.
No 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 note that this is not medical advice and you should speak with your doctor or cardiologist before commencing any exercise.