Coronary Artery Dissection (SCAD): Types, Symptoms, Treatment

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Advice From Harvard Health Publishing: Why Is Spontaneous Coronary Artery Dissection (SCAD) Dangerous?

A coronary artery dissection" target="_blank">spontaneous coronary artery dissection is a tear in the inner wall of one of the heart's arteries. The resulting flap or swelling inside the artery wall obstructs normal blood flow, which can cause a heart attack. The condition strikes both sexes but is more common in women, especially women under age 50.

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Heart Attack Symptoms In Women Are Not What You'd Expect

When you think of a heart attack, the image that likely comes to mind is a person clutching at their chest or feeling numbness in their left arm. Whether you intended to or not, this conjured image was probably a guy.

For a while, heart problems were thought of as a man's disease. And for good reason — heart disease is the leading cause of death in American men. But that doesn't mean women are immune to problems of the heart.

We now know that heart attacks are a danger to both men and women. In fact, one in five women die from heart disease. Older women are especially vulnerable. The National Institute of Health (NIH) reports women getting more heart attacks at older ages than men. Menopause is likely the culprit as the drop in estrogen increases belly fat, high blood pressure, and other factors that increase a person's risk of clogged arteries.

"Misdiagnosis and under-treatment are critical pieces to the reason that women die of heart disease more than all cancers combined," says Suzanne Steinbaum, MD, a cardiologist who specializes in menopausal women's health. "If there are risk factors and a woman is postmenopausal, she should be assessed for evidence of plaque in the arteries."

The issue is that the hallmark symptoms we associate with heart attacks like chest pain happen more in men than women. A now well-cited 2003 NIH study found that just 30 percent of the 515 women surveyed had any kind of chest discomfort while they experienced a heart attack.

Heart attack symptoms for women can be distressingly more vague and subtle. But as problematic as heart attacks are for women, they are also one of the most preventable. Recognizing early warning signs can help you put the brakes on an impending heart attack.

Extreme fatigue

Extreme and unexplained tiredness is one of the most reported heart attack symptoms among women. That's because your heart is under massive stress as it tries to pump blood to a blocked area.

In the NIH study, 70 percent of women reported a wave of fatigue that creeps up a month or two before the actual attack. The fatigue should be so detrimental that it affects your day-to-day activities.

"For some, it's so severe that they can't make a bed without resting as they tuck the sheets. It interferes with their normal activities," Jean C. McSweeney, PhD, a professor at the University of Arkansas for Medical Sciences in Little Rock, told NBC News.

Sleep disturbance

If you're suddenly having trouble sleeping at night, this could be your body warning you of high blood pressure. High blood pressure is one of the major risk factors for a heart attack. Blood pressure normally goes down during sleep but when you have trouble sleeping, it stays elevated. A 2023 study in Clinical Cardiology found that insomnia and getting less than 5 hours of sleep is both associated with an increased risk of heart attack years after.

As you wake up, your heart rate and blood pressure spikes causing cardiac stress as your heart works harder to get you up and moving.

Back, neck, or jaw pain

When an artery is clogged and blood flow is blocked, people can feel an immense pressure or squeezing in their chest. Women more than men are more likely to experience the painful pressure in other places such as the upper back, neck, and jaw, and shoulder blades. "If it happens during times of exertion, it should be taken seriously," Radha Kachhy, MD, a cardiologist told DukeHealth. "One of my patients said her shoulder hurt every time she walked. She thought it was her purse, but her shoulder throbbed even when she wasn't holding her purse."

The discomforting pressure can start off gradual or intense and may even come and go before becoming impossible to ignore.

Indigestion

Heart failure can cause abdominal swelling, which can appear as indigestion. Nearly 40 percent of women report indigestion a month before the cardiac event.

Other tell-tale signs that are often overlooked are nausea, lack of appetite, and vomiting. Puking because of heart problems is called cardiogenic vomiting. When the heart is too injured or is unable to receive oxygen-rich blood, heart tissue starts to die. The dying heart cells releases toxins that stimulate the nerves in charge of vomiting, giving you that sick to your stomach feeling.

"Heart attacks are more commonly missed in women and usually manifest as nausea and vomiting in women, more so than men," Jeffrey Ko, MD, an assistant clinical professor of health sciences told UC Davis Health. "If you're a woman over the age of 50, with other contributing factors such as diabetes or obesity and having these symptoms, it is advisable to go to the closest emergency room."

Flu-like symptoms

Past experience tells you waking up with chills, sweating, and light-headedness means you're coming down with the flu. However, for women, the flu-like symptoms could indicate an upcoming heart attack.

Julia Allen shared her story on a heart attack she experienced at 44 to Women's Health. Initially, she mistook it for influenza. "I felt an immediate and extreme — almost like someone shutting a door on you — sense of flu symptoms. Keep in mind, all of my flu symptoms were EXTREME. I felt tired, weak, dizzy, and nauseous."

Liz Johnson—then 39—told the American Heart Association how her flu-like symptoms were interfering with her ability to teach. She later went to the ER where they discovered she was having a heart attack. The flu-like symptoms Johnson experienced are common for people with spontaneous coronary artery dissection (SCAD). This is when there is a tear in the artery wall, letting blood pool between the layers of the artery wall. The resulting bulge from the wall blocks blood flow and damages the heart muscle. SCAD can happen at any age but is most common among women between 30 and 50.

Anxiety

Anxiety is a way of life for most Americans in today's society. More than 40 million adults have an anxiety disorder. But if you notice unusual bouts of stress or feelings of "impending doom," take a minute to breathe. Your anxiety may be trying to tell you something.

Thirty-five percent of women in the NIH study reported feelings of anxiety during their heart attack. And unlike a panic attack, the anxiety-like feeling will not go away. It may even increase in intensity over time. The anxiety stemming from a coming heart attack will also be accompanied by other physical symptoms.

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Cocco And Delilah Set To Open As Leicester's New Café Boutique

Leicester city centre is set to get a new addition to its food and drink scene this weekend, with the opening of independent cafe boutique Cocco and Delilah. As we reported in April, the business is launching in the Cank Street premises formerly occupied by entertainment attraction Leicester Simulations.

With the property having been given a dramatic makeover, Cocco and Delilah will open its doors for the first time this Saturday, May 20. While the opening of the boutique is an exciting event for diners keen to try homemade cakes in beautiful surroundings, it is also a huge moment for owner Pam Kaur Coratannai, who almost didn't get the chance to realise her dream of opening her own cafe boutique.

In December 2015, something happened to Pam that was to turn her life upside down. Aged 39, she was struck by SCAD (Spontaneous Coronary Artery Dissection) - an emergency condition which occurs when a tear forms in a blood vessel in the heart.

READ MORE: New luxury cafe boutique Cocco and Delilah opening in former Leicester city centre attraction

"I woke up and had no signs of anything being wrong, then I came down the stairs and a full blown heart attack," Pam told LeicestershireLive. "I was rushed into hospital and told that part of my artery wall had torn."

After having her left ventricle stented, Pam was able to return home. But just six days later, she was back in hospital after suffering another heart attack. "The weight of the stent pulled the ventricle down and I had another heart attack," Pam said. "I was given 24 hours to live."

Miraculously, emergency surgery saved Pam - but the trauma of the experience left its mark on her. "It's taken me years to recover. I've not had any energy, I've been on medication every day. But it did give me a new appreciation of life," said Pam, adding: "If you want something, you've just got to go for it."

Pam, who previously worked in the fashion industry, set up Cocco and Delilah as a luxury afternoon tea delivery and catering service in 2019, named after two characters in her life that aided her recovery. "Cocco was my mini lop rabbit and Delilah is my six year-old Cavapoo who has really helped with my rehabilitation," said Pam.

Owner Pam Kaur Coratannai (Image: Pam Kaur Coratannai)

With her delivery and catering service having proved hugely popular, Pam says she is now ready to give diners the chance to enjoy her food in permanent surroundings. "I feel like I've been given another chance, so I'm running with it. I've worked so hard to build up Cocco and Delilah and opening my own cafe boutique is a dream come true," Pam told LeicestershireLive.

Pam's creativity is clear from the beautiful surroundings, which she has designed herself. "I've put my heart and soul into it. It's given me the strength to say if there's anyone out there that has been hit by illness, you can push forward and do something." According to Pam, the interior was inspired by her love of books, and the way they enable us to get lost in a magical world, which she's aimed to present with a 'high-end' feel. "It's very chic, very fashion-led with a whimsical 3D storybook element," she said.

There are lovely details all around, such as the stories in the windows, about Mr and Mrs Brown the rabbits, written by Pam, faux blossom trees, colourful chandeliers and the butterflies on the walls. For those who love a selfie, there's an ideal spot, complete with a swing seat.

There will be a small menu available for the first few days, with coffees (using beans from Market Harborough's Carrara Coffee Roasters) milkshakes and cakes available - including rose and pistachio love cakes and cupcakes such as mandarin and chocolate flavour. Customers will also be able to enjoy Champagne and cocktails - with twists on the classics, such as the Sienna Laurent Mojito, named after Pam's daughter - served from the cafe's stylish Champagne and cocktail bar named Etoile (meaning 'star').

The brunch menu - with dishes such as smashed avocado, eggs benedict, pancakes and fruit bowls - and the afternoon tea menu, with options including a Champagne afternoon tea and Indian heritage afternoon tea, are due to be available from Friday, May 26. Afternoon tea requires booking at least 24 hours in advance.

Pam says she is looking forward to opening the doors to her new venture, and she will be doing so on an important date. She has chosen the Saturday that was closest to the birthday of her late sister, who died in 2007, aged 35, from ovarian cancer. "I've chosen the opening date in remembrance of my sister, whose birthday it would have been on May 22. I think she would have loved this place - although she would definitely have been bossing me around!" said Pam.

As well as enabling customers to enjoy "a nibble of luxury", Pam has plans for Cocco and Delilah to help people in the local community, by working with charities. Cocco and Delilah will open this Saturday, May 20. Opening hours will be 9am until 6pm Monday to Saturday and 10am until 5pm Sunday.

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