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SCAD: The Ultimate Heart Break

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HEART BEAT
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Two days before her 36th birthday, Rachel Doucette reached to plug in the seat belt on her youngest son's car seat when she felt a strange pain in her chest and arm.

Just a muscle pull, right?

Not hardly, she quickly realized. Within minutes, the pain was more intense than the delivery of any of her three kids.

Rachel was having a heart attack, only not the kind you probably think.

Yes, she had a blockage in her arteries that was preventing blood flow. Only it wasn't caused by a buildup of plaque, as is the case with most heart attacks. Her blockage came from a piece of artery that had inexplicably torn away. The official name of this type of heart attack is spontaneous coronary artery dissection, or SCAD.

Rachel was lucky. She got the care she needed to return to her husband and three children. She also came away with the resolve to inform others -- including medical professionals -- about the dangers of SCAD.

Last November, Rachel co-founded the SCAD Alliance, an organization that is shining a light on this condition to raise awareness and seek answers. In hopes that more SCAD stories will have the same happy ending as Rachel's, I am honored to let her continue her important mission in this space.

***

2014-06-12-RachelDoucette.jpgAll the research done so far to understand spontaneous coronary artery dissection (SCAD) has turned up only a single confirmed risk factor.

Having a heart.

That's it. No one can explain why SCAD strikes certain hearts.

However, researchers are beginning to see trends and possible clues.

  • The majority of these hearts are young -- an average age of 42, ranging from age 19 to mid-60s.
  • Mostly are females -- one-third of whom are pregnant or have recently given birth. (Only between 20 percent and 30 percent are male.)
  • Regardless of gender, these hearts belong to people who are active and healthy with no evidence of coronary artery disease or risk factors. Their cholesterol levels, blood pressure and weight are within the healthy range.

In other words, the common SCAD case involves the last people you would expect to have a heart attack. They are relatively young, fit and have "pristine" arteries.

And then... those clean arteries split. For whatever reason, a tear develops in the innermost layer of the artery. This dissection creates a flap of artery tissue that blocks blood flow, or the blood seeps between the artery layers and forms a clot. Either way, the results range from acute coronary syndrome to heart attack to sudden cardiac arrest.

Should you yourself panic about SCAD? Not yet. The data so far tells us the odds of you having a heart attack from SCAD are slim. These studies, however, are small, don't accurately reflect men, and don't account for the many who are misdiagnosed or who suffer undiagnosed sudden cardiac death.

SCAD matters, though, because it is the ultimate proof of why listening to our bodies is crucial.

Consider it this way: If you know you have risk factors for heart disease, you probably are more in tune with your symptoms. You might be followed by a cardiologist and awareness is more likely on your radar. If you do seek care for a heart attack, emergency staff hopefully would consider your health history and treat you as a cardiac patient.

But imagine the ER experience caused by SCAD. You have no history. You've been healthy, with no risk factors. Maybe you ran a 5k the weekend before. You are positive it can't be your heart. The attending physician sends you home with a prescription to treat acid reflux because you just don't look like heart disease.

SCAD is that mystery heart attack that takes people too young -- and that is why it matters.

SCAD Alliance is a nonprofit determined to conquer SCAD at the front lines. Until the day we understand the "whys" of SCAD, we must educate the medical community about stopping it before the damage starts. Each SCAD patient is the surprise of a lifetime to the ER staff and cardiologists who care for us. These professionals would attest to the value of heart attack symptom awareness -- regardless of cause. In fact, a recent roundtable of the SCAD Alliance Scientific Advisory Board affirmed this position and our organization is pleased to partner with the American Heart Association in reinforcing this lifesaving message.

Before co-founding SCAD Alliance with Katherine Leon, I served as a 2013 Go Red for Women Spokeswoman in Massachusetts. I was driven to pursue my mission with the American Heart Association because of my own delayed diagnosis of SCAD, heart attack, and bypass surgery at age 36. But I am also driven by the unknown. My father died at age 54 of a heart attack that was never understood, never diagnosed. It was just one of those "tragic" cases. Was it SCAD? I'll never know. But I can raise awareness to prevent heart attack and sudden cardiac arrest from killing others.

So to our clinician friends: If the differential diagnosis is saying "too healthy, no risk factors, under 50," let your gut kick in and say "do an EKG, check troponins and maybe an echo" to determine if the heart is involved and whether SCAD is in the equation. Your diligence in recognizing spontaneous coronary artery dissection will help SCAD Alliance and the American Heart Association save lives.

Because it's true: SCAD isn't rare, it's rare to meet a survivor. Please help us meet more survivors.

Rachel Doucette is co-founder and executive director of SCAD Alliance. She is a registered dietitian and served as a 2013 Massachusetts Heart Association Go Red for Women Spokeswoman.

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