How do cardiologists diagnose postpartum SCAD (spontaneous coronary artery dissection), and how will it affect me in future?

Doctor's Answers (1)

Hi there

I am sorry to hear of your experience. SCAD or spontaneous coronary artery dissection does sound likely given that it occurred 10 days postpartum (SCAD more likely to occur in the last trimester & in the last 4 weeks post delivery).  

ECG changes and raised troponin would be classed as Acute Coronary Syndrome (ACS) secondary to SCAD. 

SCAD is caused by a tear in the lining of the blood vessel in the heart (nowadays thought to be more due to spontaneous bleeding inside the blood vessel wall), following which blood collects in the false lumen, which then blocks the true lumen causing symptoms, ECG changes and raised troponin etc.

Occasionally there can be more severe symptoms, and thankfully that does not seem to be the case with yourself.

I note that A CTCA was performed and was normal. However, a normal CTCA does not fully exclude SCAD as even a coronary angiogram (which has higher temporal and spatial resolution than a CTCA and is performed in many centres) can occasionally miss it, unless special intracoronary imaging (IVUS or OCT) is performed.  

Of course, invasive tests carry risks of making the dissection worse, and  irrespective of how the diagnosis is made in the vast majority the tear heals with conservative treatment. It appears that my cardiology colleague suggested this, quite appropriately. 

As for your query regarding recurrence of SCAD - well, one of the theories of why SCAD occurs in pregancy is because the hormonal changes predispose the blood vessel wall to the tear. Therefore, SCAD can recur with further pregancy and it would be advisable for you to undergo preconception counselling and consider the risks carefully before proceeding.

Other screening tests may also be necessary and your cardiologist will be able to advise you on these.

In short, you have very valid questions and concerns, and as SCAD is a complex but somewhat uncommon (1.8/100000 in one series) occurrence you may need to have a full clinical consultation with the cardiologist to discuss these in detail.

In the interim there are many support groups and online associations you may find useful - SCAD AllianceBeat SCAD.

Regards

Dr Nandakumar

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