What Mothers and Younger Women Should Know About SCAD
One woman had never heard of spontaneous coronary artery dissection until it triggered her cardiac arrest. Now, she wants her peers to be informed.
What began as a fun day on the ski slopes in 2013 became a life-threatening experience for Courtney Reid Alexander.
Today, she’s spreading the word about spontaneous coronary artery dissection, or SCAD, a little-known heart condition that almost killed her.
It shouldn’t be so obscure: SCAD is considered the No. 1 cause of heart attack in women younger than 50, pregnant women and new mothers.
But SCAD wasn’t on the mind of Alexander, then 33, as she helped two of her three young children manage their ski equipment at the end of the day and experienced a sudden, severe backache and tingling in her arm.
“I could barely stand up,” she recalls.
Excruciating back pain prompted Alexander to go to the emergency room, where she was diagnosed with a pulled back muscle, given Tylenol and sent home to rest.
But the Saline, Michigan, resident never made it home. While turning into a friend’s driveway to pick up her kids, she went into sudden cardiac arrest.
She was rushed to the Michigan Medicine emergency room, where she underwent extensive cardiac testing, including a heart catheterization, which eventually led to a diagnosis of SCAD, a condition that is difficult to diagnose. SCAD patients often have no warning signs and no risk factors for heart disease.
“She had a long stay in the cardiac intensive care unit where it wasn’t initially clear whether she would fully recover,” says Michigan Medicine interventional cardiologist Brahmajee Nallamothu, M.D.
“Given the patient’s cardiac arrest and initial unresponsiveness, her body temperature was also lowered to protect her brain from injury.”
SCAD causes and dangers
Unlike a traditional heart attack caused by plaque buildup in the artery, SCAD patients experience a tear in the artery wall, also known as a dissection. The tear may create a flap that interferes with blood flow or may cause a blood clot to form.
This blockage of blood flow often leads to heart attack, cardiac arrest or, in some cases, sudden death.
As more information has become available in recent years, doctors have learned that SCAD often affects seemingly healthy women.
Researchers point to hormones, inflammation and genetics as possible risk factors for SCAD.
"Knowledge of the underlying factors that are involved — such as genetics — could help us to identify individuals at risk," says Michigan Medicine cardiologist Santhi Ganesh, M.D.
"It can provide important information for an individual once a SCAD event has occurred and provide information for the family members of SCAD patients.”
Treatment for SCAD
As a healthy, athletic person, Alexander could never have imagined experiencing cardiac arrest. But the more she learned about SCAD, the more she realized her risk, having given birth to her third child two years earlier.
After diagnosing Alexander’s condition, Nallamothu reached out to experts in the field to determine the safest treatment.
Traditional treatment of a heart attack is to open a blocked artery with a stent.
Not in this case, says Nallamothu: “If performed on a SCAD patient, a stent can further damage the artery by exacerbating the tear and should only be used in select circumstances.”
Alexander feels lucky to have received care at Michigan Medicine.
“Another hospital might have put a stent in, causing more damage to my artery,” she says.
It didn’t take long for her to bounce back.
“The patient had a full recovery with optimized medical therapy,” says Nallamothu, noting that Alexander also had an implantable cardioverter defibrillator placed to ensure a steady heartbeat if dangerous rhythms were to recur.
Says Alexander: “The pacemaker isn’t comfortable but gives me peace of mind because it’s there to save my life. This far outweighs the negative aspect of it.”
Life after SCAD
Alexander has no physical restrictions, but she tries not to overdo things.
“I work out and run, but I don’t challenge myself as much as I used to. I’m not running races,” the 38-year-old says.
Her advice to other women? Be your own advocate.
“We often put others before our own needs and health,” Alexander says. “If there is something that doesn’t feel right, get it checked out. You know yourself and your body.”
To enroll in an ongoing study of arterial diseases, including SCAD, email Santhi Genesh, M.D., at firstname.lastname@example.org. The study is supported by the National Institutes of Health and the University of Michigan Frankel Cardiovascular Center.