Oct. 25, 2021 -- Michele DeMarco was 33 years old when she woke up one Saturday morning with what felt like an elephant on her chest. She didn’t feel well the night before, but she tried not to worry. After all, she was fit, healthy, and young.
By Monday she could barely walk. She sat in the emergency department for 45 minutes, where the doctors told her she was having a panic attack. But after tests showed she was having a heart attack, she was given multiple drug tests. She had never experimented with substances beyond wine, but they had no other explanation for a woman her age, in perfect health, suffering a serious heart attack.
“They thought I was addicted to cocaine. They didn’t know what to do,” DeMarco, now 47, remembers. “They gave me about 11 medications and released me on a hope and a prayer.”
What DeMarco was experiencing was spontaneous coronary artery dissection, or SCAD, a potentially deadly tear that forms in a blood vessel in the heart.
The condition can slow or block blood flow to the heart, which leads to heart attacks, heart rhythm abnormalities, or sudden death.
Unlike SCAD, regular heart attacks are often caused by plaque buildup, blood clot, or spasm.
Like DeMarco, people who have SCAD are usually young women without previous risk factors like high blood pressure or cholesterol.
DeMarco had to two more SCAD heart attacks, with one occurring just days after the first. Ten years later, she had another -- almost exactly to the day.
Stories of health care professionals dismissing SCAD patients are far too common, says Sharonne N. Hayes, MD, director of Mayo’s SCAD Research Program. Though people of any sex and age can experience it, it is more common in women between 30 and 60.
“Like a regular heart attack, patients may experience a range of symptoms like chest pressure, pain, and shortness of breath. But what’s different is who’s having it,” Hayes says. “We don’t expect a 22-year-old to have heart attack symptoms.”
Hayes recalled a video visit she had with a patient: A Black woman in her early 30s called 911 after excruciating heart attack symptoms. The first responders insisted it was not a heart attack and left the scene.
Three hours later, the woman’s husband drove her to the hospital, where a battery of tests concluded she had SCAD.
Because the health of women, especially women of color, is so often neglected by the health care system, there is little collective knowledge on this condition.
“About 20 or 30 years ago, women were not included in clinical trials,” Hayes said. “There are conditions affecting women that we have far fewer answers and treatments for. If professionals don't understand it, it's very easy to dismiss it.”
Though SCAD causes a small percentage of heart attacks, it is responsible for more than 35% of heart attacks in women younger than age 50, according to research from the American Heart Association. The average SCAD patient is about 42 years old.
Risk factors include:
- Recent childbirth
- Underlying blood vessel conditions including fibromuscular dysplasia, which causes irregular growth of cells in artery walls
- Hereditary connective tissue diseases like vascular Ehlers-Danlos syndrome and Marfan syndrome
- High blood pressure
In recent years, researchers have found that SCAD is likely more common than previously thought, says Deepak Bhatt, MD, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital in Boston. But because it has been underrecognized and underdiagnosed, he says, past cases were likely chalked up to regular heart attacks.
It is important to differentiate SCAD heart attacks from other types, Bhatt says. For a run-of-the-mill heart attack, patients will often have a stent or balloon inserted to open the artery. But in SCAD patients, the artery can be delicate and sometimes unraveled.
Other treatment options include daily aspirin along with blood pressure medications to reduce the heart’s demand for blood.
But because there is a dearth of randomized research on the topic, Bhatt says, it is mostly observational.
Hayes encourages people who might be experiencing SCAD, particularly young women, to speak up for themselves in health care settings, even when doctors are hesitant to listen.
“Say out loud, ‘These are heart attack symptoms.’ Maybe they’ll give exceptional care off the bat, and if not, maybe they will grudgingly test you further,” Hayes says. “Say what you really feel, and if you're about to be dismissed without much of a workup, that's when you refuse to leave.”