In women who are under 50, SCAD is the most common reason for acute coronary syndrome. Expanded awareness of heart disease in women has increased recognition of SCAD, which was considered quite rare just a decade ago. Improved diagnostic tools have also helped.
For example, the blood tests to diagnose heart attacks that detect troponin (a substance released by damaged heart muscle) are now more sensitive. Women’s hearts are smaller than men’s and may therefore release smaller amounts of troponin during a heart attack. Widespread use of high-sensitivity troponin tests mean that women with heart attack symptoms are more likely to be diagnosed with a possible heart attack and have a heart angiogram.
The typical SCAD patient is a middle-aged, healthy woman who doesn’t seem to be a likely candidate for a heart attack (that is, she has few or none of the classic risk factors for plaque buildup in the arteries, such as diabetes, high cholesterol, or high blood pressure). About a third of SCAD cases in women occur during or soon after pregnancy, probably because blood vessels tend to soften and become more fragile during those times.
The exact cause of SCAD isn’t entirely clear. But there’s a strong link between SCAD and fibromuscular dysplasia (FMD), a rare condition marked by narrowing and enlargement of medium-sized arteries throughout the body, especially those leading to the kidneys, neck, and head. About 70% of people diagnosed with SCAD have some sort of vascular abnormality in the blood vessels outside of the heart. Most have FMD, but some have rare genetic conditions that affect connective tissue.
At least a third of people with SCAD have a history of depression or anxiety. And two-thirds recall severe physical or emotional stress before their artery dissection. For example, they may have experienced a death in the family, a job loss, a car accident, or a child’s serious illness.
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