A few days ago, the annual 14th Bulgarian course on coronary physiology with international participation was held in Borovets, organized by Prof. Plamen Gatsov. The forum discussed topics related to the modern treatment of various heart diseases - when to place a stent, when to perform a bypass, etc. What is SCAD… Two of the leading cardiologists in Serbia, Dr. Aleksandar Jolic (right, Vice President of the Serbian Society of Cardiology) and Prof. Dr. Vladimir Mitov, Director of the Interventional Cardiology Department at the Zajčar Medical Center, speak to FAKTİ.
- Dr. Jolic and Dr. Mitov, what is SCAD and why do more women suffer from this disease?
- Vladimir Mitov: The main problem is related to female hormones. We do not know exactly what happens in the coronary arteries, but very often this is related to an increase or decrease in female hormones. When we have an increase in female hormones, swelling occurs in the coronary artery, where the level of these hormones changes. When the level of hormones starts to decrease, this swelling also decreases and a space forms in the artery wall. It is there that a space is formed in the middle layer of the vessel, where the small blood vessels (small arteries and capillaries) that feed the artery itself rupture and begin to bleed. This leads to the formation of a hematoma and dissection of the wall of the coronary artery. This leads to a condition that can lead to the rupture of the blood vessel and, respectively, to hemorrhage.
- Why does this happen more often in younger women?
- Vl.M.: Again, I come back to the fact that it is about female hormones.
- Alexander Yolich: In young women, hormones are in much larger quantities, while in older women, we are talking about women in menopause, they do not have such hormones. When we talk about women in menopause, then we are already talking about other risks related to the heart. But in young women this very often leads to heart attacks. It is in younger women that hormonal changes can lead to such bleeding.
- Besides hormones, are there other factors that can cause SCAD?
- Vl. M.: Yes. It is not just about female hormones. Very strong stress leads to the release of large amounts of stress hormones, which can also damage the arteries and provoke SCAD.
- So, strong stress can also provoke the disease?
- Al. Y.: Yes, that's right. This rapid production of hormones can cause problems with the arteries. A separate factor is also related to smoking in women at a young age. This cannot be ignored.
- What are the main risk factors for the development of SCAD?
- Vl. M.: First of all, it is the female gender. Another factor that should be paid very close attention to is the age between 40 and 50 years.
- Why is diagnosing SCAD sometimes so difficult?
- Al. Y.: Because sometimes it looks like a regular heart attack, but in fact it is not. This is the big problem. If we treat the patient as in acute coronary syndrome and place a standard stent, the hematoma can spread to the proximal or distal part of the artery, which can lead to rupture of the vessel.
- If you have to explain it more simply?
- Vl. M.: In a classic heart attack, the stent saves lives. However, in SCAD, if there is a hematoma and we place a stent, after about a month the hematoma disappears, and the stent remains in an artery that is already completely healthy. Therefore, the approach to treatment is different.
- What are the chances of a full recovery after SCAD?
- Al. Y.: Recurrences of SCAD are not very common. To reduce the risk of a new episode, prevention is the most important, including treatment with beta-blockers.
- What lifestyle do you recommend for women who have already experienced SCAD?
- Vl. M.: There are no special restrictions. There are no restrictions regarding pregnancy either. If a woman has experienced SCAD, she can then become pregnant and have children, although pregnancy itself is one of the specific risk factors for developing this disease.
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SCAD (Spontaneous Coronary Artery Dissection or SCAD) is a heart emergency in which the inner layer of an artery that feeds the heart tears. It is the leading cause of heart attack in young women without risk factors for atherosclerosis. The tear in the arterial wall creates a false channel in which blood collects. This blocks normal blood flow to the heart muscle and causes a heart attack. The condition mainly affects women (about 80-90% of cases) in their mid-40s and 50s. Symptoms include sudden, severe chest pain, shortness of breath, sweating, nausea, and pain radiating to the left arm or jaw. Unlike a classic heart attack, SCAD is not due to a blockage with plaque. Diagnosis is made in a hospital setting through coronary angiography. Unlike standard heart attacks, treatment for SCAD is often conservative (drug-based), as the damaged artery has the ability to heal on its own over time. Invasive procedures (stent placement) are undertaken only in life-threatening situations.