A coronary artery dissection is a serious heart condition that requires emergency treatment. This condition happens when one of the arteries in the heart develops a tear in its inner lining — one of the artery’s three walls.

One type of coronary artery dissection is called a spontaneous coronary artery dissection (SCAD). This happens when the tear in the inner lining causes blood to build up between the layers. This can cause a blood clot to form, blocking blood flow to the heart muscle. The blood clot can also grow as platelets and other substances build up.

This type of dissection sometimes occurs in the aorta, the large artery that delivers blood from the heart to most of the body. When it does, the condition is called an aortic dissection.

SCAD occurs more often in women who are over 50 years old or postmenopausal, according to a 2015 review. But it is also a common cause of heart attack in women before menopause. Research from 2014 suggests that aortic dissection is most common among men in their 60s and 70s. But both conditions can develop in anyone at any age.

Read on to learn more about SCAD symptoms, types, causes, and treatments.

Symptoms of aortic dissection and SCAD are similar to signs of a heart attack, and include:

  • chest pain
  • shortness of breath
  • pain in one or both arms
  • pain in the shoulders, neck, or jaw
  • cold sweat
  • nausea
  • dizziness

Sudden, severe chest pain and shortness of breath should always be treated as medical emergencies — even if other symptoms aren’t present or don’t seem as serious.

When to seek emergency medical help

If you believe you or a loved one is experiencing a heart attack, call 911 or local emergency services immediately.

The pain associated with an aortic dissection, as opposed to SCAD or a heart attack, can feel like something is tearing or splitting inside your chest.

By contrast, heart attack pain is often described as a pressure, heaviness, or tightening sensation.

Symptoms of aortic dissection can also appear more like those of a stroke than a heart attack, such as:

  • weakness or numbness on one side of the body
  • difficulty speaking or understanding speech
  • vision problems
  • dizziness, near fainting, or fainting

These are the usual symptom patterns for these conditions, but there can be variations. Because there is significant overlap in symptoms between SCAD, aortic dissection, and heart attack, symptoms alone can’t diagnose them.

Each of these conditions is potentially life-threatening and requires immediate medical attention. At the hospital, doctors will be able to conduct a physical exam and run tests to determine the root cause of your symptoms.

According to the American College of Cardiology (ACC), there are three main types of SCAD.

SCAD typeDescription
type 1A noticeable flap can be seen using contrast dye and coronary angiography.
type 2This is the most common type of SCAD, according to a 2017 review. It’s identified by a significant narrowing or obstruction of the affected artery.
type 3The least common type of SCAD resembles atherosclerosis. It’s actually due to blood collections, but without any narrowing of other coronary arteries, which is typical of traditional atherosclerosis.

Experts divide aortic dissections into two categories, based on the location of the tear.

Aortic dissection typeDescription
type AThe most common type usually occurs where the aorta extends outward from the heart.
type BThis type occurs in the descending aorta, after it goes from the head down to the legs.

It’s not always clear why SCAD or other types of artery dissections occur, though there are known risk factors.

For example, a 2021 study found that women are much more likely than men to develop SCAD. Most women who experience SCAD are in their 40s and 50s, but people who are pregnant or recently gave birth are also at higher risk of SCAD.

Men are more likely than women to experience an aortic dissection.

A 2019 study notes that the following conditions raise the risk of both SCAD and coronary artery dissection:

Other risk factors for SCAD and other types of artery dissections include poorly controlled high blood pressure, atherosclerosis, and other vascular conditions.

Strenuous exercise, particularly weightlifting, has also been identified as a risk factor for SCAD and aortic dissection.

SCAD is often first diagnosed when someone has a heart attack. The first steps in diagnosing a heart attack include:

  • an electrocardiogram (EKG) to monitor your heart’s electrical patterns and rhythms
  • a blood test to measure troponin, a protein that’s released into your blood after a heart attack

SCAD is present in about 1 in 4 heart attacks in women under the age of 60. A person with heart attack symptoms may be evaluated for atherosclerosis, a narrowing and stiffening of the arteries. According to the American Heart Association, if no atherosclerosis is found, a doctor should test for SCAD.

Coronary angiography is the main method of diagnosing SCAD. As part of this invasive test, a thin plastic tube called a catheter is placed inside your artery. Through that catheter, a special dye is injected into the bloodstream that can only be detected by X-rays. A coronary angiogram can detect problems with blood flow, and can often show the location of the dissection and its severity.

According to a 2014 study, intravascular ultrasound (IVUS) is often used alongside coronary angiography to confirm a diagnosis of SCAD. This type of imaging can help assess the exact location and extent of a tear in the artery.

IVUS is a catheter-based procedure that occurs under a mild sedative. A small tube with an ultrasound probe on the end is inserted into the heart and guided by your doctor. This probe sends signals to a computer, creating cross-sectional images. These images provide a real-time 360-degree view of the area of the heart being imaged. IVUS is frequently used to guide the placement of a stent to treat blocked arteries.

Doctors may also diagnose an aortic dissection using one or more of the following imaging tests:

If a doctor determines that your aortic dissection is mild and that no interventions are needed right away, they may prescribe certain medications to lower your blood pressure and slow your heart rate.

Medications to treat mild SCAD also include antihypertensive drugs and blood thinners to lower the risk of a blood clot forming at the site of the tear.

If medications aren’t enough to treat the condition, you may need surgery or a catheter-based procedure aimed at treating the injured artery.

For SCAD, open heart surgery can be performed to bypass the damaged artery with a blood vessel from elsewhere in the body.

An aortic dissection may be repaired surgically. If the aortic valve in the heart is also damaged, a replacement valve may need to be inserted.

In addition to medical therapy and invasive procedures, the Heart and Stroke Foundation of Canada says that managing a coronary artery dissection or SCAD often means adopting certain heart-healthy behaviors.

Some important lifestyle changes include:

  • getting regular exercise as approved by a doctor
  • avoid heavy weightlifting and contact sports
  • maintaining a moderate weight
  • following a heart-healthy diet, such as the Mediterranean diet
  • managing your blood pressure with medications if necessary
  • reducing or quitting smoking, if you smoke
  • lowering stress
  • attending cardiac rehabilitation

A 2017 study says that a doctor may recommend taking beta-blockers along with some of these lifestyle changes. Also, visit a cardiologist regularly to monitor your heart health.

Healthy arteries are essential to making sure you have adequate blood flow throughout the body.

If a coronary artery tears, the heart muscle can suffer due to a reduction in oxygen-rich blood. If the aorta tears, the consequences may be fatal without surgery.

But SCAD and aortic dissection are often treatable if you get immediate medical help. After that, follow a doctor’s guidance on medications and lifestyle changes to prevent further cardiac complications.