BOSTON – Many patients who experience a type of heart attack known as spontaneous coronary artery dissection (SCAD) may benefit most from a conservative approach to treatment, rather than more invasive procedures. A scientific statement reviewing current knowledge and best practices for SCAD treatment – put together by a collaborative working group from multiple institutions including Massachusetts General Hospital (MGH) – was published today in the American Heart Association (AHA) journal, Circulation.
Occurring most frequently in young, otherwise healthy women, SCAD is often misdiagnosed or not recognized by providers, the authors note. This new statement aims to increase awareness and understanding, while also laying out guidelines for detecting and treating SCAD.
“This is an exciting step forward, because for far too long we’ve seen major gaps in the knowledge that exists on SCAD around the country and the world,” says Malissa Wood, MD, lead physician in the MGH SCAD Program and a co-author of the statement. “My hope is that this statement will clear up a lot of the confusion surrounding SCAD for both patients and providers.”
Most heart attacks occur due to atherosclerosis, a dangerous buildup of plaque inside a coronary artery that blocks blood supply to the heart muscle. In SCAD, a dissection or tear occurs inside the artery, which may cause a blockage or disruption of blood flow, leading to a heart attack.
SCAD was first documented in 1931 and for decades was believed to be a rare condition. Recent research suggests otherwise, due to a growing increase in the number of recognized cases year to year. SCAD is now considered the number one cause of heart attack in women under age 50.
In 2015 MGH launched a program devoted to studying SCAD and has the only multidisciplinary SCAD program in the Northeast.
“Here at MGH we have the tools for detecting SCAD, which include things like intravascular imaging,” says Mark Lindsay, MD, an MGH cardiologist and another co-author of the AHA statement. “For facilities where the proper imaging tools might not exist, we believe this statement now offers an important guide for providers to reference when exploring a SCAD diagnosis that may, if necessary, hasten access to the right care.”
The causes of SCAD can vary and are believed to include diseases of the arteries, genetic factors, hormonal influences in pregnant and postpartum women, emotional and environmental stressors, and less commonly, connective tissue diseases.
Women with SCAD may experience the classic heart attack symptoms – such as discomfort in the chest and upper body, shortness of breath, nausea and light-headedness – but may be misdiagnosed due to lack of conventional cardiovascular risk factors.
The statement also notes that in most patients who did not receive stents, the artery dissections healed on their own within weeks and months. For some, the healing began within days.
“Every case is different, but in some patients, we’ve seen that placement of a stent can tear the artery even further,” says Wood. “Allowing the artery to heal and treating patients with medications like blood thinners has been shown to be beneficial.”
Additionally, the statement points to cardiac rehabilitation as a key piece of recovery from SCAD. The MGH Cardiac Rehabilitation Program teaches safer exercise, meditation and stress management for SCAD patients.
Wood and Lindsay underscore the need for additional study of SCAD to further deepen the understanding of short- and long-term cardiovascular risks and SCAD management. Limited prospective studies have been done, but larger-scale prospective and epidemiological studies will still need to be conducted in the future, says Wood.
To learn more about the MGH SCAD Program, please visit: http://www.massgeneral.org/heartcenter/services/spontaneous-coronary-artery-dissection.aspx.
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $900 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, genomic medicine, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals and earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service. In August 2017 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of "America's Best Hospitals."