Rebecca presented to the emergency department with chest and back pain as well as shortness of breath. She had originally thought it was indigestion, but antacids did not improve her symptoms. At the hospital, Rebecca undergoes several tests and examinations that show she has elevated troponin levels and has experienced a spontaneous coronary artery dissection (SCAD). Rebecca is diagnosed with SCAD and recommended conservative management.
Rebecca is shocked by the diagnosis while her husband is frustrated by the management plan recommended. They are both reassured that SCAD is rare and could not have been prevented or predicted; however, Rebecca does not have a blood flow blockage and SCAD will heal over time without surgery.
Whilst still in hospital Rebecca was followed up with the cardiology team and had further investigations. This included blood tests to establish her cholesterol & hormonal levels, a head-to-hip CTA to screen for connective tissue disorders, an echocardiogram, and a validated psychological screening tool to assess Rebecca’s mental health. The results from these assessments were considered normal and nothing of further concern was identified.
The cardiology team provided Rebecca and her husband with individually tailored advice and support to help manage her symptoms and optimise her long-term clinical outcome.
After being discharged from the hospital, Rebecca attended her local cardiac rehabilitation programme. She had an initial consultation and health checks that considered her cardiovascular risk factor profile as well as her menstrual and pregnancy history. Following her initial assessment, Rebecca and the Cardiac Rehab team agree she will start cardiac rehabilitation classes.
Overall, this scenario:
- Defined what SCAD is.
- Explained SCAD risk factors, diagnosis, and treatment options.
- Highlighted that SCAD most commonly occurs in women in their 40s and 50s
- Discussed why examination and investigations should comprehensively extend beyond traditional cardiovascular risk factors and should incorporate menstrual and pregnancy histories and hormonal profiles, and optimisation of medical therapy.
- Discussed how screening for connective tissue disorders is important to ensure there are no problems in the other arteries of the body
- Highlighted that a SCAD diagnosis can cause uncertainty, distress and worry for the affected individual and their family.
- Signposts to relevant health services.
- Provides resources for additional information.
Well done, you have reached the end of this section.
What do you want to do next?
