Causes of Spontaneous Coronary Artery Dissection (SCAD)

Primary Causes and Mechanisms

Spontaneous coronary artery dissection is predominantly caused by a combination of predisposing arteriopathies and precipitating stressors, with the highest prevalence in young women, particularly during the peripartum period 1
The pathophysiological mechanism involves spontaneous formation of an intramural hematoma within the coronary artery wall, with or without an intimal tear 1
SCAD accounts for up to 4% of all acute coronary syndromes but represents 20-35% of acute coronary syndromes in women under 60 years of age 2, 3

Fibromuscular dysplasia (FMD) is present in up to 72% of SCAD patients and represents the strongest association with SCAD 4, 5
Connective tissue disorders including systemic lupus erythematosus, Marfan syndrome, and other genetic arteriopathies predispose to weakened arterial walls 1
Pregnancy and the peripartum period represent significant risk factors, with SCAD being particularly prevalent during this time 1
Hormonal fluctuations may contribute to arterial wall weakening, especially in women 2, 3

Intense emotional stress can trigger SCAD in predisposed individuals 4, 5
Physical stressors including intense exercise, Valsalva-type activities, or labor and delivery can precipitate SCAD 1, 4
Hypertension is an independent predictor of recurrent SCAD 4, 5

Over 90% of SCAD cases occur in women 5
The condition disproportionately affects young to middle-aged women without traditional cardiovascular risk factors 1

SCAD should be suspected in any young woman presenting with acute coronary syndrome without traditional risk factors 1
Diagnosis is confirmed by coronary angiography, potentially supplemented by intracoronary imaging (OCT or IVUS) 5

Conservative management is preferred for stable patients, as revascularization attempts can worsen dissections 5
Beta-blockers are strongly recommended for long-term management as they reduce recurrence risk 4, 5
Aggressive blood pressure control is essential as hypertension increases recurrence risk 4, 5

Cardiomyopathies, including SCAD, are rare but represent severe causes of cardiovascular complications in pregnancy, according to the European Heart Journal 6
Peripartum SCAD is particularly rare but represents a significant cause of pregnancy-associated acute coronary syndromes, as reported by the European Heart Journal 6

Pregnancy-related hormonal changes contribute to structural alterations in the collagen of vessel walls, increasing vulnerability to dissection, as found in a study published in the European Heart Journal 7
Thrombi and dissections occur more frequently in the peripartum period than before delivery, as noted in research published in the European Heart Journal 8