CCC 2015: Is She Really Having a Heart Attack?

November 19, 2015

Spontaneous coronary artery dissection (SCAD) is a dangerous condition that is not well understood. It primarily affects women in their 30s to 50s who have no standard risk factors for heart disease. A tear forms in the wall of an artery allowing blood to pool between the inner and outer layers of the blood vessel wall. This can constrict the artery or cause a clot to form, restricting or cutting off blood flow to the heart. The result can be a heart attack or sudden death.

Bonnie Bowes, Director of Quality, Risk Management & Privacy, and Erika MacPhee, Regional Cardiac Care Co-ordinator, reported on the Ottawa Heart Institute’s efforts to develop standards of care in the absence of best practice guidelines for SCAD.

As Bowes and MacPhee explained, the condition used to be considered rare, with diagnosis often made at autopsy. Improvements in coronary angiography have increased the number of SCAD diagnoses, but with more cases being identified, the knowledge gap about the condition is becoming a pressing concern.

Factors associated with SCAD include pregnancy, connective tissue disorders, hormone treatment, and fibromuscular dysplasia. Patient education is an important aspect of care due to physical activity restrictions and the high likelihood of recurrence. Rehabilitation, vocational support and coordination with specialists outside the cardiac sphere are often needed.

The Clinical Services team at the Heart Institute is in the process of creating patient education materials that will cover signs and symptoms of SCAD, treatment options, follow-up care and restrictions associated with physical activity and pregnancy. Bowes indicated that the materials will be available soon on the Heart Institute website.

The Heart Institute is also participating in the Canadian SCAD Study to better understand the nature of the condition.