Experts recommend more conservative care for SCAD heart attacks

By Allen Cone  |  Feb. 22, 2018 at 1:18 PM
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Feb. 22 (UPI) -- If a younger woman suffers a certain type of heart attack, the American Heart Association and Mayo Clinic are now recommending letting the body heal on its own.

Spontaneous coronary artery dissection, or SCAD, is a type of heart attack that occurs mainly in women between the ages of 45 to 53 when a tear happens inside an artery, causing a blockage.

The statement, published by the AHA in its journal, Circulation, says that a conservative approach is best for treating SCAD patients.

"It may seem counterintuitive, but we discovered that treating SCAD the same way we treat heart attacks due to atherosclerosis can cause further tearing and damage to the vessel," Dr. Sharonne Hayes, a Mayo Clinic cardiologist who founded its Women's Heart Clinic, said in a press release. "But the initial proper diagnosis is critical in guiding the care."

When Hayes noted that SCAD was more prevalent among survivors on social media than thought, she started a pilot study in 2010 with a registry, as well as a DNA and plasma biobank that contains samples from approximately 400 SCAD patients and nearly 200 of their parents.

Most heart attacks occur when plaque builds up in arteries over a lifetime, but a SCAD heart attacks start with a tear in an artery. The tear then blocks the artery and blood flow to the heart, leading to a heart attack.

SCAD, which is responsible for 40 percent of heart attacks in women under the age of 50, occurs in individuals who have few conventional cardiovascular risk factors such as high blood pressure, unhealthy cholesterol levels or smoking.

SCAD is believed to be caused by diseases of the arteries, genetic factors, hormonal influences and, less commonly, connective tissue diseases. Environmental factors can also be a factor, researchers say.

"Even with what we have learned over the past several years, SCAD continues to be misdiagnosed and underdiagnosed," Hayes said. "And we know it is not rare. It is the No. 1 cause of heart attack during pregnancy and in the period right after giving birth, and the No. 1 cause of heart attack in women under age 50."

Hayes said the condition is often misdiagnosed because emergency room personnel don't suspect a heart attack because they don't not have typical heart disease risk factors. This judgement is despite patients having discomfort in the chest and upper body, shortness of breath, nausea and light-headedness.

And Hayes said misdiagnoses can happen if the patient is unnecessarily sent to the catheterization lab, where stents are often used to open blocked arteries.

Most patients without stents found the dissections healed on their own within weeks and months. For some, the healing even began within days, Hayes said.

Also recommended is an emphasis on tailored cardiac rehabilitation programs and addressing mental health.

"Anxiety and depression are common in SCAD survivors, and they often are being treated by health care providers who have little familiarity of the disease or in providing psychosocial support," Hayes says. "We've found that online support groups can be immensely helpful in addition to finding a care team that is responsive to patients' concerns."

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