A recent case report has brought attention to a rare but potentially life-threatening cause of heart attack: spontaneous coronary artery dissection (SCAD) in a young woman without classic risk factors for cardiovascular disease. As BMJ Journals reports, this case not only highlights the importance of recognizing atypical presentations of acute coronary syndrome but also underscores the need for awareness of SCAD, especially among younger and otherwise healthy individuals.
Case Overview: A Sudden Onset of Chest Pain
The patient, a young woman in her 30s with no significant history of hypertension, diabetes, or high cholesterol, presented to the emergency department with acute, severe chest pain radiating to her left arm. Electrocardiogram (ECG) findings and blood tests pointed toward a heart attack, but her age and lack of risk factors prompted further investigation.
Coronary angiography (a specialized imaging test to visualize the heart’s arteries) revealed an unexpected diagnosis: a spontaneous tear in one of her coronary arteries. This tear, or dissection, led to the formation of a false channel within the artery wall, restricting blood flow to the heart muscle and causing her symptoms.
Understanding SCAD: An Uncommon Culprit
SCAD is a rare event, responsible for a small proportion of all heart attacks, but it disproportionately affects younger women, often those without typical cardiovascular risk factors. The exact cause remains unclear, but hormonal changes (such as those during pregnancy), connective tissue disorders, or extreme emotional or physical stress may play a role.
Unlike heart attacks caused by atherosclerosis (plaque buildup), SCAD occurs when the artery wall itself splits, creating an internal blockage. This makes diagnosis particularly challenging, as traditional risk profiles may not apply.
Management and Recovery
Treatment of SCAD differs from that of typical heart attacks. In many cases, conservative management with medications and close monitoring is preferred, as the affected artery can heal on its own over time. In this patient’s case, she was stabilized with medication and observed in the hospital, with repeat imaging confirming gradual improvement.
Invasive procedures like stenting or bypass surgery are reserved for cases with ongoing chest pain, significant blood flow compromise, or life-threatening complications. Long-term, patients require regular follow-up, lifestyle modifications, and sometimes cardiac rehabilitation to support recovery.
Lessons for Clinicians and Patients
This case emphasizes that heart attacks are not limited to older adults or those with well-known risk factors. For clinicians, maintaining a high index of suspicion for SCAD in young women presenting with chest pain is crucial, as timely diagnosis can be lifesaving. For patients, it is a reminder that sudden, severe chest pain should never be ignored, regardless of age or health status.
