Reston Hospital Center - October 28, 2019

Why new moms are most at risk for this kind of heart attack

A different kind of heart attack has attracted the attention of researchers - because it targets new moms. Spontaneous coronary artery dissection, shortened to SCAD, is a rare, but significant issue that causes a disproportionate number of women, particularly those who are pregnant or have given birth, to experience chest pain and a heart attack.

SCAD is a sneaky health problem because it impacts young women who are generally very healthy and don't fit the typical heart attack profile. SCAD symptoms are often ignored by those suffering from it, and can even be missed by doctors.

Recent efforts by the American Heart Association and medical researchers to raise awareness of this condition suggest SCAD may be far more common than previously thought, especially in young women. Being aware of SCAD risks and symptoms is critical to helping identify it quickly.

What is SCAD?

Your artery walls are made up of three layers of tissue. During SCAD a tear in the innermost layer allows blood to to become trapped between the other layers, causing a bulge in the wall that blocks blood flow to the heart. Total blockage causes a heart attack. Partial blockage causes chest pain and other symptoms.

Who is at risk for SCAD?

First, let's establish that SCAD is a rare condition, accounting for 1 to 4 percent of acute coronary syndrome cases overall. It can occur at any age, but is most commonly seen in otherwise healthy people between the ages of 30 and 50. What’s startling is that SCAD is far more common in women than men. In fact, one-third of all SCAD cases occur during pregnancy or soon after giving birth.

Risk factors for SCAD include:

  • Female gender
  • Pregnancy or giving birth
  • Fibromuscular dysplasia (FMD), a disease that causes abnormal cell development in the artery wall
  • Extreme exercise
  • Underlying blood vessel inflammatory disease, like lupus
  • Connective tissue disease, like Marfan syndrome
  • Very high blood pressure
  • Illegal drug use

How does pregnancy increase the risk?

The American Heart Association’s 2018 Scientific Statement on SCAD explains that estrogen and progesterone have been shown to weaken blood vessel walls, which could leave them more vulnerable to the kind of tears that results in SCAD. Experts believe the significant hormonal changes during pregnancy, birth and the postpartum period may indicate that fluctuating hormone levels could contribute to SCAD, rather than the hormones themselves.

Other elements of pregnancy and birth can contribute to SCAD too. These include increased blood volume, pushing during vaginal labor, and mental health conditions like chronic stress, depression, and anxiety.

What are the symptoms of SCAD?

Chest pain or chest pressure are the major symptoms of a heart attack for anyone, but women's symptoms can be nuanced and subtle. These symptoms can include:

  • Pain in the jaw, stomach, back, neck, and arms
  • Nausea or vomiting
  • Dizziness
  • Shortness of breath severe enough to be unignorable

A lot of women, new moms in particular, ignore these symptoms or attribute them to other causes. SCAD affects many people who haven't yet reached the average heart attack age, which is over 70 for women, or even the age when the risk of heart attacks begins to rise, which is 55 in women.

The AHA statement says SCAD could be responsible for up to 35 percent of heart attacks in women 50 years or younger. The others tend to be due to atherosclerosis.


Though it is rare, the medical community wants to raise awareness about the risk of SCAD during and after pregnancy. Because new moms experiencing symptoms don't have the typical risk factors for heart disease, and their symptoms might not align with traditional heart attack warning signs, they sometimes don't receive proper diagnosis and treatment — or worse are discharged after being evaluated in the ER. Getting the right diagnosis is crucial when it comes to treating SCAD, which can range from repairing the tear, to letting SCAD heal with monitoring and medication.

The Final take-away

If you experience chest pains or other symptoms and are younger than expected for a heart attack and are pregnancy or have recently given birth, ask your doctors if they've considered SCAD as the cause of your symptoms.

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