Spontaneous Coronary Artery Dissection (SCAD) Guide: Symptoms, Causes, Diagnosis, and Treatment
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: September 2026
TL;DR
Spontaneous coronary artery dissection (SCAD) is an emergency condition in which a tear forms in the wall of a heart artery, slowing or blocking blood flow to the heart and potentially causing a heart attack, irregular heartbeats, or sudden death. It most often affects women in their 40s and 50s — people who typically lack standard heart disease risk factors like high blood pressure, high cholesterol, or diabetes. Blood enters the split between artery wall layers, clots (an intramural hematoma), and narrows the artery. Treatment ranges from medicines alone (and sometimes no treatment at all, as SCAD can heal on its own) to stent placement or bypass surgery. Because it can recur even years later, follow-up and heart-healthy lifestyle steps matter — and any heart attack symptoms warrant an immediate 911 call [1] [2].
Quick Answer
What is SCAD? An emergency condition in which a tear forms in the wall of a heart artery, slowing or blocking blood flow to the heart and leading to a heart attack, irregular heartbeats, or sudden death.
Who gets it? Most commonly women in their 40s and 50s — but it can happen at any age and in men. People with SCAD often lack typical heart disease risk factors.
What causes it? The exact cause is not known. Seven risk factors raise the odds, from recent childbirth and extreme stress to fibromuscular dysplasia and connective tissue syndromes.
How is it diagnosed? Usually in an emergency setting — blood tests, an electrocardiogram (ECG), a coronary angiogram (the test that can diagnose SCAD), and sometimes optical coherence tomography or intravascular ultrasound during the angiogram.
How is it treated? Medicines (aspirin, blood pressure medicines, and chest pain medicines) may be all that's needed — sometimes SCAD heals on its own. Stents (angioplasty/PCI) or bypass surgery (CABG) are used when blood flow is blocked or pain persists.
What This Guide Is Based On
This guide is built entirely from specialist-reviewed clinical guidance updated April 2026, alongside the Journal of the American College of Cardiology JACC state-of-the-art SCAD review (2020), the New England Journal of Medicine SCAD clinical review (2020), UpToDate spontaneous coronary artery dissection overviews, and the American Heart Association's coronary artery dissection patient education [1] [2].
What Is SCAD?
Spontaneous coronary artery dissection — called SCAD for short — is an emergency condition [1]. It happens when a tear forms in the wall of a heart artery. The tear can slow or block blood flow to the heart, which can lead to a heart attack, irregular heartbeats, or even sudden death [1].
Here is the mechanical picture. A tear develops on the inside of a coronary artery, allowing blood to create a split between two layers of the artery wall. This may leave a loose flap of tissue on the inside of the artery. The split may stay small — but the blood pooled between the layers can clot, forming what is called an intramural hematoma. That clot can make the normal artery channel narrow, blocking blood flow to the heart [1].
A key point that sets SCAD apart: a heart attack caused by SCAD is different from a heart attack caused by clogged arteries (atherosclerosis). The vessel isn't blocked by plaque buildup — it is compromised by a tear in its own wall [1].
Who Gets SCAD?
SCAD most commonly affects women in their 40s and 50s. But it is not limited to that group: it can happen at any age and can occur in men [1].
Perhaps the most defining characteristic of SCAD: people who have it often don't have the usual risk factors for heart disease — no high blood pressure, no high cholesterol, no diabetes. That is exactly what makes it easy to miss and why it catches so many patients and families off guard [1].
And because it can be fatal quickly: SCAD can cause sudden death if it isn't treated right away. The standing advice is to get emergency medical help if you have heart attack symptoms — even if you think you aren't at risk of a heart attack [1].
What Are the Symptoms?
SCAD symptoms overlap heavily with a typical heart attack. The full list to know:
Possible sign or symptom | What it means |
Chest pain or pressure | The classic cardiac warning sign |
Pain in the arms, shoulders, back, or jaw | Pain that radiates from the chest |
Shortness of breath | Difficulty breathing normally |
Unusual sweating | Sweating beyond what the situation calls for |
Extreme tiredness | Unusual, pronounced fatigue |
Upset stomach | Stomach discomfort that isn't digestive |
A rapid heartbeat or fluttery feeling in the chest | Palpitations or fluttering |
Feeling dizzy | Lightheadedness |
When Should You Seek Emergency Care?
This is not a "schedule an appointment" condition. Call 911 or your local emergency number if you have chest pain or think you might be having a heart attack. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Do not drive yourself unless you have no other choice [1].
What Causes SCAD?
Straight answer: the cause of spontaneous coronary artery dissection is not known [1]. It is "spontaneous" in the truest sense — the tear forms without an obvious external trigger like trauma. What medicine can describe is the profile of people it tends to strike, which is where the risk factors come in.
What Are the Risk Factors?
Seven factors raise the risk of SCAD:
Risk factor | Details |
Being assigned female at birth | SCAD can happen to anyone, but it tends to affect women more than men |
Childbirth | Some women with SCAD recently gave birth; hormone changes and blood-vessel stress from pregnancy may play a role. It usually happens in the first few weeks after delivery, but can occur during pregnancy |
Extreme stress | SCAD can happen after extreme stress, including intense exercise and severe emotional distress |
Fibromuscular dysplasia (FMD) | A condition that weakens the body's medium-sized arteries; can lead to an aneurysm or artery rupture (dissection). Women are more likely to have FMD than men |
Genetic conditions affecting connective tissue | Ehlers-Danlos and Marfan syndromes have been found in people who have had SCAD |
Very high blood pressure | Severe high blood pressure can raise the risk of SCAD |
Illicit drug use | Cocaine or other illicit drugs might increase the risk of SCAD |
What Are the Complications?
SCAD's complications mirror its mechanism. The main one is a heart attack: SCAD slows or stops blood flow through the artery, which weakens the heart — but remember this is a different kind of heart attack from one caused by clogged arteries [1].
The structural problem can also worsen: in some people, the inner and outer layers of the artery split, and blood collecting between these layers adds pressure that can make SCAD worse [1].
And SCAD is not a one-and-done event. Even with successful treatment, SCAD can happen more than once — soon after the first episode or years later. Survivors also face a higher risk of other heart conditions, such as heart failure due to heart attack damage [1].
How Is SCAD Diagnosed?
SCAD is usually diagnosed in an emergency setting [2]. You may be asked about your personal and family medical history, and tests are done to check your heart. The tests resemble those used to detect a heart attack [2]:
Diagnostic test | What it does |
Blood tests | After heart damage from a heart attack, some heart proteins slowly leak into the blood; tests check for these proteins, plus other blood tests may be done |
Electrocardiogram (ECG or EKG) | A quick test of the heart's electrical activity — sensor patches on the chest, and sometimes arms and legs, connect by wires to a computer. It shows how fast or slow the heart is beating and whether you are having or have had a heart attack |
Coronary angiogram | The test that can diagnose SCAD. A thin, flexible catheter is placed into an artery — usually in the groin or wrist — and guided to the heart. Dye flows through the tube, helping the arteries show up on X-ray images and video |
Optical coherence tomography (OCT) | Performed during the angiogram to confirm SCAD and plan treatment. Uses light beamed from the catheter to see inside the blood vessels and vessel walls; helps accurately diagnose the cause of a heart attack |
Intravascular ultrasound (IVUS) | Also done during the angiogram. A device on the catheter's end emits sound waves, and a computer turns the bounce-back into pictures of the inside of the heart arteries |
How Is SCAD Treated?
Treatment has three goals: fix blood flow to the heart, manage chest pain, and prevent SCAD from happening again. Approaches range from medicines to surgery that opens the artery and restores blood flow — and in some cases, SCAD heals on its own. The right treatment depends on your overall health and the size and location of the tear in the artery [2].
Medications
Some people with SCAD only need medicines to treat symptoms — and if chest pain or other symptoms continue, other treatments might be needed [2].
Medicine type | What it does |
Aspirin | Long-term aspirin may help lower the risk of heart disease after SCAD; talk with your healthcare professional about whether daily aspirin therapy is right for you |
Blood pressure medicines | Several options are available; you might take them for life to reduce the risk of another SCAD |
Chest pain medicines | Nitrates and calcium channel blockers can help treat chest pain after SCAD |
Surgery and Other Procedures
Some people need a procedure or surgery to fix the artery and improve blood flow to the heart [2]:
Coronary angioplasty and stent (PCI) may be needed if SCAD blocks blood flow to the heart or medicines don't control chest pain. A doctor guides a catheter (usually from the groin or wrist) to the heart; a small balloon on the catheter tip widens to open the artery; then a tiny mesh tube — a stent — is placed inside to hold the artery open and improve blood flow. The balloon comes out; the stent stays. This treatment is also called percutaneous coronary intervention [2].
Coronary artery bypass surgery (CABG) is open-heart surgery that creates a new path for blood to flow around a blocked or partially blocked artery. It may be done if other SCAD treatments don't work or if there is more than one tear. The surgeon takes a healthy blood vessel (a graft) from the chest or leg area — one end is stitched to the artery below the blockage, the other to the heart. Also called heart bypass surgery or coronary artery bypass grafting — pronounced "cabbage" [2].
Pregnancy After SCAD
One warning that matters: if you've had SCAD, talk with your healthcare professional before becoming pregnant. Pregnancy may not be safe after SCAD [2].
Cardiac Rehabilitation
After treatment, you need regular checkups with your healthcare team. A personalized program of exercise and education — cardiac rehabilitation (cardiac rehab) — may be suggested. It helps you recover from a serious heart condition and typically includes supervised exercise, emotional support, and education about a heart-healthy diet [2].
What Lifestyle Steps Help After SCAD?
Eight home-care measures protect the heart after SCAD [2]:
Lifestyle measure | What it involves |
Don't smoke or use tobacco | Smoking is a major heart disease risk factor; avoid secondhand smoke too, and ask your team for quitting strategies |
Eat healthy foods | Whole grains, fruits, vegetables, and lean proteins (fish, beans); avoid or limit saturated fat, trans fats, salt, and sugar |
Exercise | With your team's OK, 30 to 60 minutes of activity most days; after SCAD, you may be told to avoid intense lifting, competition, and extreme temperatures |
Keep a healthy weight | Extra weight strains the heart and raises the risk of high cholesterol, high blood pressure, and diabetes |
Limit alcohol | If you drink, up to one drink a day for women and two for men |
Manage blood pressure, cholesterol, and blood sugar | Ask how often your levels should be checked |
Practice good sleep habits | 7 to 9 hours of sleep daily; consistent bed and wake times, including weekends |
Manage stress | Exercise, mindfulness, and connection with support groups |
How Can You Cope and Find Support?
Understanding SCAD helps. Two practices stand out [2]:
Coping strategy | What it means |
Learn about SCAD | Knowing the details makes conversations with your care team easier. Ask about the size and location of your artery tear, the treatments you'll receive and why you need them, and where to find more information |
Join a support group | Connecting with others who know what you're going through may help; ask your team about SCAD or heart disease support groups in your area |
How Should You Prepare for Your Appointment?
A candid note from the clinical guidance: you may not have time to prepare — SCAD usually is diagnosed in an emergency [2]. That reality is itself the point: the only realistic "preparation" is knowing the symptoms above and acting on them immediately by calling 911 rather than waiting to see if they pass.
Conclusion
SCAD breaks the heart-attack script: no plaque, no decades of high cholesterol, often a healthy woman in her 40s or 50s suddenly struck by a tear in her own artery wall. The eight warning signs are the same ones as any heart attack — which means the right response is always the same: call 911 immediately, never drive yourself. The diagnostic path runs through blood tests, ECG, and the coronary angiogram that reveals the tear, with OCT and IVUS confirming it. Treatment is adaptable — medicines alone, sometimes nothing at all as SCAD heals on its own, or stents and bypass for blocked flow — but the condition doesn't disappear after treatment: it can recur years later, and a new pregnancy deserves a conversation with your doctor first. If heart symptoms strike and you don't "fit" the typical profile, take them seriously anyway.
This guide is for general information only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.
Frequently Asked Questions
What exactly is SCAD?
Spontaneous coronary artery dissection is an emergency condition in which a tear forms in the wall of a heart artery, slowing or blocking blood flow to the heart. It can lead to a heart attack, irregular heartbeats, or sudden death.
Who gets SCAD?
It most commonly affects women in their 40s and 50s, but it can happen at any age and in men. Notably, people who have SCAD often don't have the typical heart disease risk factors such as high blood pressure, high cholesterol, or diabetes.
What causes SCAD?
The exact cause is not known. The tear forms spontaneously inside the artery wall; blood then enters the split between the wall layers and can clot (forming an intramural hematoma), narrowing the artery and blocking blood flow to the heart.
What are the warning signs?
Chest pain or pressure; pain in the arms, shoulders, back, or jaw; shortness of breath; unusual sweating; extreme tiredness; upset stomach; a rapid heartbeat or fluttery feeling in the chest; and feeling dizzy.
What should I do if I have these symptoms?
Call 911 or your local emergency number if you have chest pain or think you might be having a heart attack. If emergency medical services aren't available, have someone drive you to the nearest hospital — do not drive yourself unless you have no other choice.
How is SCAD diagnosed?
Usually in an emergency setting, through blood tests (looking for heart proteins leaking into the blood), an electrocardiogram (ECG), and a coronary angiogram — a catheter guided to the heart with dye that shows the arteries and can diagnose SCAD. Optical coherence tomography and intravascular ultrasound may be performed during the angiogram to confirm it.
How is SCAD treated?
The goals are to restore blood flow, manage chest pain, and prevent recurrence. Some people need only medicines — aspirin, blood pressure medicines (often for life), and nitrates or calcium channel blockers for chest pain. If blood flow is blocked or pain persists, angioplasty with a stent (PCI) or coronary artery bypass surgery (CABG) may be needed. Sometimes SCAD heals on its own.
Can SCAD come back?
Yes. Even with successful treatment, SCAD can happen more than once — soon after the first episode or years later. People who have had SCAD also have a higher risk of other heart conditions, such as heart failure from heart attack damage, which is why regular checkups, cardiac rehab, and heart-healthy lifestyle habits matter.
References
Additional references consulted:
Hayes SN, et al. "Spontaneous coronary artery dissection: JACC state-of-the-art review." Journal of the American College of Cardiology, 2020.
Kim ESH. "Spontaneous coronary-artery dissection." The New England Journal of Medicine, 2020.
Saw J. "Spontaneous coronary artery dissection." UpToDate.
American Heart Association. "Coronary artery dissection: Not just a heart attack." heart.org, 2023.
Teruzzi G, et al. "Spontaneous coronary-artery dissections: A systemic review." Journal of Clinical Medicine, 2021.
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