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What Is Coronary Artery Dissection?
Coronary artery dissection occurs when blood enters a split within the wall of a coronary artery, creating a buildup that can narrow or block blood flow to the heart muscle. Spontaneous coronary artery dissection, or SCAD, happens without a clear outside injury or procedure and may occur even without severe coronary artery disease. It can affect adults who otherwise appear healthy, including people without many traditional heart disease risk factors. Prompt medical assessment is important because reduced blood flow can cause a heart attack.
Emergency Warning Signs
Emergency Warning Signs
Seek emergency care
Urgent symptoms
Sudden or severe symptoms that could signal a heart attack require calling emergency services immediately. Do not drive yourself to the hospital.
- Chest pressure or pain
- Shortness of breath
- Fainting
- Cold sweats
- Nausea
- Pain spreading to the arm, back, neck, or jaw
Symptoms may be severe or mild, and you should not wait for them to improve. Seek immediate help when symptoms are new, sudden, or worsening, even if they seem manageable or you have few traditional cardiovascular risk factors.
Symptoms
Symptoms of Coronary Artery Dissection
- Chest pain or pressure
- Shortness of breath
- Pain spreading to the arm
- Pain spreading to the shoulder
- Pain spreading to the back
- Pain spreading to the neck
- Pain spreading to the jaw
- Sweating
- Nausea
- Dizziness
- Palpitations, or a feeling of a racing or irregular heartbeat
- Fainting
Symptoms of a dissected artery can resemble a heart attack and may begin suddenly. Urgent assessment is needed even when symptoms are mild or the person has few traditional cardiovascular risk factors.
Causes
Causes of Coronary Artery Dissection
A coronary artery dissection begins with a tear in the inner lining of the artery or bleeding within the artery wall. Blood then creates a false channel between the wall layers, which can compress the normal passage and reduce blood flow. Many cases are spontaneous, meaning that no single direct cause is identified.
Triggers and associated conditions
SCAD is associated with conditions such as fibromuscular dysplasia and inherited connective-tissue disorders. Pregnancy and the postpartum period, intense emotional stress, extreme physical exertion, and severe inflammatory or vascular conditions may also be associated with some events. These factors do not cause every spontaneous artery dissection, and many people have no clear trigger.
Risk Factors
Risk Factors for Coronary Artery Dissection
Associated factors
SCAD is more often reported in women and in middle adulthood. Pregnancy or the postpartum period, fibromuscular dysplasia, and inherited connective-tissue disorders are also associated with increased likelihood. These factors are not proof that a dissection will occur.
Possible triggers
Intense physical exertion, severe emotional stress, and certain inflammatory or vascular conditions may precede some events. However, spontaneous coronary artery dissection can occur without obvious risk factors or an identifiable trigger.
Conventional atherosclerosis risk factors may coexist with SCAD, but they do not fully explain spontaneous coronary artery dissection. Patients should not blame themselves for the event; medical evaluation focuses on identifying associated conditions and reducing future risks.
Complications
Complications of Coronary Artery Dissection
- Heart attack can occur when the dissection severely reduces blood flow to heart muscle.
- Abnormal heart rhythms can develop when reduced blood flow affects the heart’s electrical system.
- Heart failure may result when the heart muscle is weakened or damaged.
- Cardiogenic shock can occur when the heart cannot pump enough blood to support the body.
- Cardiac arrest is a life-threatening loss of effective heart activity.
- Recurrent coronary artery dissection can affect the same artery or another blood vessel.
Prognosis depends on how much blood flow is affected, how quickly treatment begins, the location and extent of the dissection, and whether complications occur. A ruptured artery or severe obstruction requires immediate specialist care.
Diagnosis
How Coronary Artery Dissection Is Diagnosed
Clinicians assess symptoms, vital signs, and heart function. Common tests include an electrocardiogram, blood tests for heart injury such as troponin, and echocardiography. These tests may show a heart attack or reduced heart function, but they do not always confirm the dissection itself.
| Test | What it shows | Typical role | Important consideration |
|---|---|---|---|
| Coronary angiography | Contrast outlines the coronary arteries and areas of narrowed flow | Often used urgently to assess the artery and guide treatment | Invasive and may not clearly show the full wall tear |
| Coronary CT angiography | Detailed images of the coronary arteries and surrounding structures | May help assess stable patients or follow selected cases | Image quality can be limited by heart motion, heart rate, or small vessels |
| Intravascular ultrasound or optical coherence tomography | Images the artery wall and false channel from inside the vessel | May clarify an uncertain dissection during angiography | Invasive and can potentially extend the dissection or require additional contrast |
The cardiology team selects imaging based on stability, artery location, image quality, and the risks of invasive testing. Not every patient needs every test, and a dissected artery may be diagnosed without using all available imaging methods.
Treatment & Management
Treatment and Management
Treatment is individualized by a cardiology team and may include hospital monitoring, medicines to reduce clotting or control blood pressure, and treatment for chest pain or heart attack complications. Medication choices must account for the artery’s anatomy, blood flow, heart function, and bleeding risk. Some stable dissections heal with medical management, while others require a procedure.
| Approach | When it may be considered | What it involves | Key considerations |
|---|---|---|---|
| Conservative medical management | Stable patients with preserved blood flow and no ongoing ischemia | Monitoring, symptom treatment, and individualized medicines | Requires close follow-up; the dissection can progress or recur |
| Percutaneous coronary intervention with a stent | Ongoing ischemia, severe obstruction, complications, or unstable condition | A catheter-based procedure places a stent to support the narrowed artery | Can be technically difficult and may extend the dissection |
| Coronary artery bypass surgery | Extensive disease, unsuitable anatomy, or failed or unsuitable stenting | A graft creates a new route around the affected artery | Major surgery with recovery time and procedure-related risks |
Long-term care may include cardiac rehabilitation, a gradual return to physical activity, blood pressure management, and follow-up imaging or cardiology visits when indicated. Clinicians may evaluate for associated vascular conditions such as fibromuscular dysplasia or connective-tissue disorders. Do not start, stop, or change antiplatelet or anticoagulant medicines without medical guidance.
Outlook and Prognosis
Outlook and Prognosis
Many people recover after coronary artery dissection, particularly when blood flow is restored or preserved and complications are avoided. Recovery varies according to the amount of heart muscle damage, heart function, treatment needs, and overall health. Follow-up helps the care team address symptoms, activity, and emotional recovery.
Long-term follow-up and recurrence
Recurrence can affect another coronary artery or another blood vessel, so ongoing cardiology follow-up is important. Evaluation for fibromuscular dysplasia or connective-tissue disorders may be appropriate. Guidance about exercise, pregnancy, and stress should be individualized for each person with a dissected artery.
