What is Spontaneous Coronary Artery Dissection?
Spontaneous coronary artery dissection (SCAD) is an important, non-atherosclerotic cause of acute coronary syndrome (ACS) that predominantly affects women, with a typical age of presentation in the 40s. While only accounting for 2-4% of all ACS, it can account for 35% of MI in women younger than 50 years.
Patients often present with classic ACS symptoms such as chest pain. It can present as STEMI or NSTEMI. An acute SCAD event will always have a rise in the cardiac troponin, reflecting true myocardial injury. Because SCAD can closely mimic atherosclerotic ACS, all patients should be treated with ACS management until the SCAD diagnosis is confirmed.
Coronary angiography is required for diagnosis and typically demonstrates characteristic patterns of dissection or intramural hematoma. Management is generally conservative, as most dissections heal spontaneously. Medical therapy usually includes a short course of dual antiplatelet therapy followed by long-term aspirin, along with beta-blockers, which are a cornerstone of therapy and associated with reduced risk of recurrence. Anti-anginal agents are frequently needed for chest pain, at least in the short term as 1 in 3 SCAD patients will have some residual symptoms. Revascularization is reserved for high-risk features such as ongoing ischemia, hemodynamic instability, or left main involvement.
Given the strong association between SCAD and fibromuscular dysplasia (FMD), patients should undergo vascular imaging (typically CT angiography of the head/neck/Circle of Willis and abdomen/pelvis) to screen for extracoronary arteriopathies. Comprehensive care also includes referral to cardiac rehabilitation, with counseling to avoid heavy lifting, high-intensity isometric exercise, and Valsalva-type activities. Long-term follow-up in a dedicated SCAD clinic is recommended to support medical management, recurrence surveillance, and patient education, recognizing the unique physical and psychosocial needs of this population.
https://www.scadnavigator.com/
https://sunnybrook.ca/wp-content/uploads/2025/12/ABCs-FAQs-for-SCAD_Final.pdf
https://www.ottawaheart.ca/heart-condition/spontaneous-coronary-artery-dissection
