Spontaneous Coronary Artery Dissection Leads to Heart Attack
November 18, 2021
While visiting New Zealand in the summer of 2019, 49-year-old Devorah “Devi” Snively began having a strange feeling in her upper right chest. The dull soreness went away overnight, but came back the next day as she hiked. This time she also felt soreness in her jaw and in the back of her neck. Her right arm felt tingly and painful, but the symptoms subsided and she didn’t seek medical attention. Overnight, she awoke with that dull soreness in her chest again, but she ignored it as she felt it didn’t seem serious. She was young, thin and fit. The next day after a workout, Devi got a migraine and felt lightheaded and nauseous. She vomited for eight hours. Finally, she admitted she needed to go to the hospital.
Tests determined that Devi had suffered a heart attack. She didn’t get much more information in New Zealand, but when she returned to the U.S. she found Heather Gornik, MD, cardiologist with University Hospitals Harrington Heart & Vascular Institute. Dr. Gornik reviewed images taken at the cardiac catheterization lab in New Zealand and discovered what they hadn’t: Devi had experienced SCAD which lead to her heart attack.
SCAD stands for Spontaneous Coronary Artery Dissection. According to data from the American Heart Association, the condition causes a small percentage of heart attacks overall, but is responsible for 40 percent of heart attacks in women under the age of 50. The average SCAD patient is just 42.
Typical heart attacks are caused by plaque and/or a blood clot that blocks a heart artery. But SCAD starts with a tear or bleed in the wall of a heart artery which blocks blood flow to the heart, causing a heart attack.
Symptoms of SCAD include chest pain or discomfort, shortness of breath, pain in the shoulders, arms, back, neck or jaw, nausea, lightheadedness and sweating.
Like Devi, SCAD patients are generally healthy and have no or few risk factors for heart disease. They aren’t overweight, smokers or diabetic, so even if they seek treatment for classic heart attack symptoms, they’re often misdiagnosed with problems like anxiety or indigestion. Misdiagnosis can lead to treatment that may cause more damage.
Dr. Gornik also diagnosed Devi with Fibromuscular Dysplasia (FMD). This disease causes cells to grow abnormally in artery walls and is seen in at least half of people with SCAD. Luckily for Devi, she lived through the SCAD and it healed on its own. She now takes medicine to help prevent another event and completed a cardiac rehabilitation exercise program. Devi continues to attend regular follow-up appointments with her doctor.