What are the symptoms of Spontaneous Coronary Artery Dissection (SCAD)?

Symptoms of Spontaneous Coronary Artery Dissection (SCAD)

The most common presenting symptom of SCAD is chest discomfort, reported in approximately 96% of patients, typically manifesting as acute myocardial infarction that may be either ST-elevation MI (25.7%) or non-ST-elevation MI (74.3%). 1

Primary Symptoms

• Chest discomfort: Typically described as pressure, tightness, or heaviness in the chest 2
• Radiating pain: Often extends to:
  • Arms (49.5%) 1
  • Neck (22.1%) 1
  • Jaw 2
  • Upper back 2
• Associated symptoms:
  • Nausea or vomiting (23.4%) 1
  • Diaphoresis/sweating (20.9%) 1
  • Dyspnea/shortness of breath (19.3%) 1
  • Back pain (12.2%) 1

Severity and Presentation

• All SCAD patients present with myocardial infarction 3
• Approximately 25.7% present with ST-segment elevation MI 3
• 74.3% present with non-ST-segment elevation MI 3
• 8.9% experience ventricular tachycardia or ventricular fibrillation 3
• Cardiac arrest occurs in approximately 1% of cases 1

Timing and Onset

• Symptoms may develop after emotional stressors (48.3% of cases) 3
• Physical stressors can trigger symptoms in 28.1% of patients 3
• Average time from symptom onset to hospital presentation is 1.1 ± 3.0 days 1
• Approximately one-third (34.2%) of patients have unstable symptoms upon arrival for coronary angiography 1

Important Clinical Considerations

• SCAD is often underdiagnosed and is an important cause of myocardial infarction, especially in young women 3
• 90.5% of SCAD patients are women, with an average age of 52.5 years 3
• SCAD should be suspected in patients with chest pain who have:
  • Few or no traditional cardiovascular risk factors
  • Recent extreme emotional or physical stress
  • Peripartum status
  • History of fibromuscular dysplasia (present in 62.7% of SCAD patients) 3

Diagnostic Challenges

• SCAD may be missed during initial evaluation because:
  • Symptoms can mimic those of typical atherosclerotic coronary disease
  • Standard coronary angiography may not clearly show the dissection 4
  • Multiple angiograms may be required before SCAD is identified 4
  • Symptoms may be dismissed as non-cardiac, especially in young women 4

Post-SCAD Symptoms

• Recurrent chest pain is common even after treatment 4
• Long-term cardiovascular events occur in approximately 19.9% of patients 3
• Recurrent SCAD occurs in about 10.4% of patients 3

Warning Signs of Unstable SCAD

• Persistent or worsening chest pain despite rest
• New-onset or worsening dyspnea
• Syncope or pre-syncope
• Palpitations associated with hemodynamic compromise
• Patients with unstable symptoms are more likely to require repeat angiography (65.7%) and revascularization (14.9%) 1

SCAD is a distinct clinical entity that requires high clinical suspicion, particularly in young women presenting with acute coronary syndrome symptoms but without traditional cardiovascular risk factors. Prompt recognition and appropriate management are essential to improve outcomes.