Causes and risk factors
The artery is made up of three layers- outer, middle and inner layer. The outer layer is called as tunica externa, middle layer is called as tunica media and inner layer is called as tunica intima. Due to tear of these layers the arterial lumen becomes narrow. The flow of blood is obstructed due to which the blood supply to the heart is reduced leading to heart attack. The exact cause however is still not known. As the incidence is high in females it is assumed that there must be some link between SCAD and hormonal changes. It is more commonly seen in patients who have fibro muscular dysplasia. SCAD can also be caused due to iatrogenic causes i.e. during a surgery on the coronary artery while inserting a catheter. Substance abuse (cocaine addiction), hypertension, extreme physical exertion etc also contribute to the causation.
Clinical presentation
The complaints mostly occur during rest or during exercise. A person having SCAD comes up with complaints of pain in chest. The pain can be either mild or severe. Compression is felt in the region of the chest or most of the times the patient complaints of burning sensation in the chest. The pain can be dull aching, piercing of stabbing in nature. Heartburn is the other symptom of which many patients often complain of. The pain is located to the sternal region and may radiate to the left arm and fingers. Pain in jaw is occurs. Radiation to back, neck or shoulder region also occurs. The patient sweats profusely. Fatigue, nausea, vomiting and breathlessness are the other accompanying symptoms.
Investigations
Diagnosis is done on the basis of the symptoms narrated by the patient and attendant. The vital signs of the patients are monitored. The following investigations and physical examination can also be done. Intravascular ultrasound and optical coherence tomography are diagnostic. ECG, Chest X ray, 2D echo, serum enzymes levels, and routine blood test along with angiogram can be advised. Certain other investigations can also be advised by the doctor.
Treatment
SCAD is a medical emergency and immediate medical help is needed to prevent complications and death. Cardiopulmonary stabilization is the first line of treatment .Medications like pain relieving, ACE inhibitors, blood thinning agents or thrombolytic are given intravenously or sublingually. Surgical intervention consists of coronary artery bypass grafting. A fat and sugar free diet is advised for those with high cholesterol levels or for diabetic patients. For the first two days a semi solid diet is advised. Complete bed rest is essential.
