Last year 52 year old airline pilot Camilla Jago was shocked when she suffered excruciating chest pain which radiated out to her arms. She knew she was having a heart attack because as a pilot she is trained to recognize the symptoms. What she didn’t know was this was no ordinary heart attack but a condition called SCAD (Spontaneous Coronary Artery Dissection).SCAD is different to a normal heart attack because it is not caused by furring up of the arteries but is a result of one or more inner layers of the artery tearing away from the outer layer. The torn flap of arterial wall creates a haemotoma or blockage in the blood flow to the heart leading to angina, heart attack or sudden cardiac arrest.
The strange thing is that 80% of people who suffer SCAD are women-particularly during or soon after pregnancy. This is why experts at Leicester Royal Infirmary believe it is linked to female hormones or extreme physical exertion. Dr Abi Al Husseini is lead researcher on SCAD and believes that it may also be related to an underlying connective tissue problem.
The big problem is that most doctors have never heard of it and so may never have treated it. Often women who have had SCAD are given medication or worse interventional treatment such as a stent, because their only knowledge is based on a normal heart attack. In the case of SCAD this is not the treatment these women need. Sometimes, particularly when there is good flow in the affected artery the best treatment is to leave it to heal by itself.
“We know you don’t treat these patients the same way as someone who has had a heart attack” explains Dr Al Hussaini. “They are women, they are young and fertile and have a healthy lifestyle. They only need a stent if the flow of blood is not good”.
“We do know that the pathology, prognosis and management are different for SCAD. The way we rehabilitate patients who have had SCAD is probably also different. those who have had more conservative management of SCAD tend to do a lot better because the artery has healed on its own. They simply go on aspirin for a year and if the heart function is OK they do not need any other treatment” she adds.
Luckily for Camilla she was treated at Brighton Hospital where the registrar had heard of SCAD and stopped the cardiologist from inserting a stent. It was there she was put in touch with the SCAD support group which was set up by other women who had suffered this type of heart attack. There is now a growing database of patients at Leicester who are currently liaising with the Mayo Clinic in the US to discover more about the causes of SCAD so that treatment can improve.
For more information about SCAD go to http://www.scad.lbru.le.ac.uk
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