7 Warning Signs of Spontaneous Coronary Artery Dissection (SCAD) You Shouldn’t Ignore

Spontaneous coronary artery dissection (SCAD) is a rare but serious heart condition that occurs when a tear forms in one of the blood vessels supplying the heart. Unlike typical heart attacks caused by plaque buildup, SCAD can strike otherwise healthy individuals without traditional risk factors. This condition is particularly common in younger women and can be life-threatening if not recognized promptly. Understanding the warning signs of a SCAD heart attack is crucial for early detection and appropriate medical intervention.

SCAD accounts for approximately 1-4% of all acute coronary syndrome cases, yet many people remain unaware of its existence. The spontaneous nature of this condition means it can occur without warning, making awareness of its symptoms essential for anyone, especially women between ages 30-60. In this comprehensive guide, we’ll explore the key symptoms that may indicate SCAD and what you need to know about this cardiovascular emergency.

1. Sudden, Severe Chest Pain

The most prominent and alarming symptom of a SCAD heart attack is sudden, intense chest pain that appears without warning. This pain is often described as a crushing, squeezing, or pressure-like sensation in the center or left side of the chest.

Unlike chest discomfort from indigestion or muscle strain, SCAD-related chest pain typically:

• Begins abruptly and intensifies rapidly
• Feels like an elephant sitting on your chest or a tight band squeezing around your ribcage
• Lasts longer than a few minutes and doesn’t improve with rest
• May come and go in waves of varying intensity
• Differs significantly from any chest discomfort you’ve experienced before

This chest pain occurs because the tear in the coronary artery wall disrupts blood flow to the heart muscle, causing ischemia. The severity of pain doesn’t always correlate with the extent of the dissection, meaning even moderate discomfort should be taken seriously if accompanied by other symptoms.

2. Pain Radiating to Other Body Parts

SCAD frequently causes pain that spreads beyond the chest area, radiating to other parts of the upper body. This referred pain is a classic hallmark of cardiac events and should never be dismissed.

Common radiation patterns include:

• Left arm and shoulder: The most typical pattern, with pain traveling down the inner aspect of the left arm, sometimes reaching the fingers
• Jaw and teeth: Unexplained jaw pain or toothache, particularly on the left side, without dental problems
• Neck and throat: Discomfort that feels like a choking sensation or tightness in the throat
• Back: Pain between the shoulder blades or in the upper back region
• Upper abdomen: Discomfort in the upper stomach area that might be mistaken for digestive issues

The radiation of pain occurs because the heart and these areas share similar nerve pathways. The brain sometimes misinterprets signals from the heart as coming from these other regions, a phenomenon called referred pain.

3. Shortness of Breath and Breathing Difficulties

Difficulty breathing is a critical symptom of SCAD that may occur independently or alongside chest pain. This dyspnea happens because the heart cannot pump efficiently when its blood supply is compromised.

Breathing difficulties associated with SCAD may manifest as:

• Sudden inability to catch your breath, even at rest or during minimal activity
• Feeling like you cannot get enough air despite breathing rapidly
• Shallow, rapid breathing that doesn’t relieve the sensation of breathlessness
• Breathing problems that worsen when lying flat and improve when sitting upright
• A sensation of suffocation or drowning

Some individuals experience shortness of breath as their primary or only symptom, particularly women. This symptom may appear minutes to hours before other signs become evident. If you suddenly find yourself gasping for air without an obvious cause like exercise or anxiety, especially if accompanied by other symptoms on this list, seek emergency medical attention immediately.

4. Extreme Fatigue and Weakness

Unexplained, overwhelming fatigue is a frequently overlooked symptom of SCAD, particularly in women. This isn’t ordinary tiredness from lack of sleep or a busy day—it’s a profound exhaustion that feels abnormal and debilitating.

SCAD-related fatigue typically presents as:

• Sudden onset of extreme tiredness without having engaged in strenuous activity
• Feeling completely drained of energy, as if you could collapse
• Difficulty performing simple tasks that normally wouldn’t tire you
• Weakness in the limbs, particularly the arms and legs
• A heavy, leaden sensation throughout the body
• Fatigue that appears days or even weeks before the acute event in some cases

This symptom occurs because when the heart’s blood supply is compromised, it cannot pump oxygen-rich blood effectively to the rest of the body. The resulting reduced oxygen delivery to muscles and organs creates profound exhaustion. Women are more likely than men to experience fatigue as a primary symptom of a SCAD heart attack, making it especially important not to dismiss this warning sign.

5. Nausea, Vomiting, and Digestive Distress

Gastrointestinal symptoms frequently accompany SCAD and are often misattributed to stomach flu, food poisoning, or indigestion. These symptoms result from the body’s stress response to cardiac distress and reduced blood flow to the digestive system.

Digestive symptoms associated with SCAD include:

• Nausea: Persistent queasiness that doesn’t resolve and may intensify with movement
• Vomiting: May occur once or repeatedly, without relation to food intake
• Indigestion: A burning sensation or discomfort in the upper abdomen that antacids don’t relieve
• Abdominal pain: Discomfort in the upper stomach that might mimic gallbladder or ulcer pain
• Loss of appetite: Sudden disinterest in food accompanied by general malaise

The vagus nerve, which serves both the heart and digestive tract, is responsible for these symptoms. When the heart is under stress, signals along this nerve can trigger gastrointestinal distress. Women experiencing SCAD are particularly likely to report these symptoms, sometimes without classic chest pain, which can lead to dangerous delays in diagnosis. If you experience unexplained digestive symptoms along with any other items on this list, don’t assume it’s simply a stomach problem.

6. Cold Sweats and Clamminess

Breaking out in a cold, clammy sweat without obvious cause is a distinctive symptom of cardiac events including SCAD. This isn’t the warm perspiration from exercise or hot weather—it’s a cold, sticky sweat that appears suddenly and feels markedly different from normal sweating.

SCAD-related sweating characteristics include:

• Sudden onset of profuse sweating, particularly on the face, neck, and upper body
• Cold, clammy skin that feels moist to the touch
• Pale or grayish skin color accompanying the sweating
• Sweating that occurs even in cool environments or at rest
• A feeling of being both hot and cold simultaneously
• Perspiration that soaks through clothing despite no physical exertion

This symptom results from activation of the sympathetic nervous system—the body’s “fight or flight” response—when the heart is in distress. The body releases stress hormones like adrenaline, which trigger sweating and other physiological changes. Cold sweats combined with chest discomfort, shortness of breath, or other symptoms should prompt immediate emergency care, as this combination strongly suggests a cardiac event in progress.

7. Lightheadedness, Dizziness, and Fainting

Feeling dizzy, lightheaded, or actually fainting can indicate that SCAD is significantly affecting the heart’s ability to pump blood effectively to the brain and body. These symptoms reflect reduced cardiac output and should be considered medical emergencies, especially when accompanied by other warning signs.

Neurological symptoms of SCAD may include:

• Lightheadedness: A floating sensation or feeling that you might pass out
• Vertigo: A spinning sensation even when standing still
• Presyncope: The sensation of impending fainting, often described as “graying out” or tunnel vision
• Syncope: Actual loss of consciousness, which may be brief or prolonged
• Confusion: Mental fog, difficulty concentrating, or disorientation
• Visual disturbances: Blurred vision or seeing spots

These symptoms occur because the compromised coronary artery cannot deliver sufficient oxygenated blood to meet the body’s needs. The brain, being highly sensitive to oxygen deprivation, responds with these neurological symptoms when blood flow is inadequate. Fainting during a cardiac event is particularly concerning as it may indicate dangerous heart rhythms or severely reduced cardiac output. If you experience unexplained dizziness or fainting along with any other symptoms discussed, call emergency services immediately—don’t attempt to drive yourself to the hospital.

Main Causes of Spontaneous Coronary Artery Dissection

Understanding what causes SCAD can help identify those at higher risk, though the exact mechanism remains not fully understood. Unlike traditional heart attacks caused by atherosclerosis, SCAD occurs when the layers of the coronary artery wall separate, creating a false channel that restricts blood flow.

Hormonal Factors

SCAD disproportionately affects women, particularly during reproductive years, suggesting hormonal influences play a significant role. Pregnancy and the postpartum period (especially the first few weeks after delivery) are times of heightened risk. Hormonal fluctuations may weaken arterial walls, making them more susceptible to tearing.

Fibromuscular Dysplasia (FMD)

This arterial disease, which causes abnormal cell growth in artery walls, is found in 50-80% of SCAD patients. FMD weakens blood vessel walls throughout the body, making them more prone to dissection. Many people with FMD are undiagnosed until a SCAD event occurs.

Extreme Physical or Emotional Stress

Intense physical exertion, such as heavy weightlifting, extreme exercise, or intense vomiting, can trigger SCAD. Similarly, severe emotional stress, major life events, or extreme psychological distress may precipitate an event. The mechanism likely involves sudden blood pressure spikes that stress arterial walls.

Connective Tissue Disorders

Genetic conditions affecting connective tissue, such as Ehlers-Danlos syndrome, Marfan syndrome, and Loeys-Dietz syndrome, increase SCAD risk. These disorders cause abnormalities in collagen and other structural proteins that provide strength to arterial walls.

Inflammatory Conditions

Systemic inflammatory diseases, including lupus, polyarteritis nodosa, and other vasculitides, can weaken arterial walls and contribute to SCAD development. Inflammation damages the structural integrity of blood vessels, making them vulnerable to dissection.

Multiparity

Having multiple pregnancies appears to increase SCAD risk, possibly due to cumulative hormonal effects on arterial walls or the physical demands of multiple gestations on the cardiovascular system.

Prevention Strategies for SCAD

While SCAD often occurs without warning in otherwise healthy individuals, certain strategies may help reduce risk, particularly for those with known predisposing factors.

Manage Physical Activity Appropriately

If you’ve had SCAD or are at high risk, consult with your healthcare provider about safe exercise levels. Avoid extremely intense or isometric exercises (like heavy weightlifting) that cause significant blood pressure spikes. Moderate, regular aerobic exercise is generally beneficial, but extreme exertion should be approached cautiously or avoided.

Control Blood Pressure

Maintaining healthy blood pressure reduces stress on arterial walls. Regular monitoring, a heart-healthy diet low in sodium, stress management, and following medical advice regarding blood pressure management are essential preventive measures.

Manage Stress Effectively

Since emotional stress may trigger SCAD, developing healthy stress management techniques is important. Consider meditation, yoga, counseling, adequate sleep, and other stress-reduction strategies. If you experience significant life stressors, seek support from mental health professionals.

Screening for Related Conditions

If you’ve experienced SCAD, screening for fibromuscular dysplasia and connective tissue disorders is recommended. Early identification of these conditions allows for appropriate monitoring and management that may reduce future risk.

Pregnancy Planning and Monitoring

Women who have had SCAD should discuss pregnancy plans with a cardiologist and high-risk obstetrician. Pregnancy after SCAD carries increased risk and requires specialized monitoring. Some women may be advised against future pregnancies depending on their specific circumstances.

Avoid Certain Medications and Substances

Some medications and substances may increase SCAD risk. Energy drinks with high caffeine content, certain hormonal therapies, and illicit stimulant drugs can stress the cardiovascular system. Discuss all medications and supplements with your healthcare provider, particularly if you have SCAD risk factors.

Regular Medical Follow-Up

If you’ve had SCAD, ongoing cardiology care is essential. Regular follow-up allows monitoring for recurrence (which occurs in 10-30% of patients) and adjustment of preventive strategies based on your individual risk profile.

Frequently Asked Questions About SCAD

Who is most at risk for SCAD?

SCAD predominantly affects women, particularly those between ages 30-60. Approximately 90% of SCAD cases occur in women. Other risk factors include pregnancy (especially the postpartum period), fibromuscular dysplasia, connective tissue disorders, multiple pregnancies, and extreme physical or emotional stress. Importantly, SCAD often occurs in people without traditional cardiovascular risk factors.

How is SCAD different from a regular heart attack?

Traditional heart attacks typically result from atherosclerosis—plaque buildup that ruptures and blocks an artery. SCAD occurs when the artery wall spontaneously tears, creating a separation between layers that blocks blood flow. SCAD patients are usually younger, more often female, and lack typical risk factors like high cholesterol, smoking, or diabetes that characterize traditional heart attack patients.

Can SCAD happen more than once?

Yes, SCAD can recur. Studies show recurrence rates between 10-30% of patients, typically occurring within the first few years after the initial event. Recurrence may happen in the same artery or a different coronary artery. This risk underscores the importance of ongoing cardiology follow-up and adherence to preventive strategies.

Is SCAD hereditary?

SCAD itself is not considered directly hereditary, though certain predisposing conditions like fibromuscular dysplasia and connective tissue disorders have genetic components. Having a family history of SCAD or related conditions may increase your risk. Researchers are investigating potential genetic factors, but no specific “SCAD gene” has been identified.

What should I do if I suspect I’m having symptoms of SCAD?

Call emergency services (911 in the US) immediately. Do not drive yourself to the hospital. SCAD is a medical emergency requiring prompt diagnosis and treatment. Time is critical in cardiac events—early intervention can prevent serious complications and save your life. Don’t wait to see if symptoms improve, and don’t dismiss symptoms because you think you’re “too young” or “too healthy” for a heart problem.

Can men get SCAD?

Yes, although SCAD is much less common in men, accounting for approximately 10% of cases. Men who develop SCAD tend to be younger and may have fibromuscular dysplasia or other predisposing conditions. The symptoms and seriousness of SCAD are the same regardless of gender.

Are there warning signs before a SCAD event occurs?

SCAD typically occurs suddenly without preceding warning signs. However, some patients report unusual fatigue, neck or jaw discomfort, or chest sensations in the days or weeks before the acute event. Unfortunately, these vague symptoms are often recognized as significant only in retrospect. This is why awareness of risk factors and prompt response to any concerning symptoms is crucial.

Does having SCAD mean I have heart disease?

SCAD is a form of acute coronary syndrome but differs from typical coronary artery disease. Most SCAD patients do not have atherosclerotic plaque buildup in their arteries. After recovery, many SCAD survivors have structurally normal coronary arteries aside from the healed dissection site. However, you will need ongoing cardiac monitoring and risk factor management.

References:

• Mayo Clinic – Spontaneous Coronary Artery Dissection
• American Heart Association – SCAD
• National Heart, Lung, and Blood Institute – SCAD
• National Center for Biotechnology Information – SCAD Research
• Cleveland Clinic – SCAD Overview