Spontaneous Coronary Artery Dissection (SCAD)
A guide to SCAD diagnosis, conservative care, intervention decisions and associated vascular conditions.
Spontaneous coronary artery dissection is a non-atherosclerotic cause of acute coronary syndrome in which bleeding or separation within the artery wall compresses the true channel. It is particularly important in younger women and during or after pregnancy, although it can affect any adult.
Diagnosis
SCAD commonly presents with acute chest pain and may cause myocardial infarction or ventricular arrhythmia. Coronary angiography is the principal diagnostic test; intravascular imaging is reserved for uncertainty because instrumentation can extend the dissection. Associated arteriopathies such as fibromuscular dysplasia may be investigated after the acute phase.
Management
When blood flow is preserved and the patient is stable, conservative management is often preferred because many dissections heal. PCI can be technically difficult and is reserved for ongoing ischaemia, instability, left-main involvement or other high-risk anatomy. Follow-up includes recurrent-symptom guidance, blood-pressure control, tailored exercise advice and discussion of pregnancy where relevant.
New chest pain after SCAD requires prompt medical assessment.
Clinical Depth and Risk Assessment
Risk is not defined by the diagnostic label alone. Symptoms, ECG and rhythm findings, ventricular function, myocardial scar or structural change, family history, associated disease and previous events are integrated. Genetic results, when relevant, require expert interpretation; a variant of uncertain significance is not equivalent to a diagnosis.
Diagnostic Strategy and Limitations
Testing is selected to answer a specific question. ECG, ambulatory monitoring, echocardiography, cardiac MRI, CT, laboratory testing, exercise assessment or invasive evaluation have complementary roles. A normal test may not exclude an intermittent disorder, while an abnormal measurement must be checked against technical quality and clinical probability.
Treatment Decision Framework
Treatment may combine risk-factor control, condition-specific medicines, rhythm or heart-failure therapy, catheter procedures, surgery and implanted devices. These options address different mechanisms and are not automatically substitutes for one another. Expected benefit, uncertainty, procedural burden and the patient’s informed preferences should be discussed explicitly.
Long-Term Follow-up
Follow-up assesses symptoms, exercise capacity, rhythm burden, ventricular function and treatment tolerance over time. Family screening may be appropriate in inherited or suspected inherited disease. New fainting, sustained rapid rhythm, chest pain, neurological symptoms or rapidly worsening breathlessness requires urgent assessment.
Questions to Discuss With the Cardiology Team
- Which finding has the greatest influence on my present risk?
- Which test or treatment would genuinely change management?
- What symptoms should lead to an earlier appointment or emergency care?
- Do relatives need clinical or genetic assessment?
Medical Information Note
This page supports an informed discussion with the clinical team. It does not provide a personal diagnosis, medicine dose or sports-clearance decision.