The information on this page is aimed mainly at healthcare professionals caring for a patient with a suspected SCAD. Advice for patients who think they may be having a SCAD is also included.
For detailed information on SCAD see our For Professionals section.
Healthcare Professionals
SCAD can lead to long-term heart damage and can (rarely) be fatal.
It’s important that a SCAD diagnosis is not delayed. The longer blood flow through a coronary artery is reduced or stopped, the higher the chance of permanent damage to heart muscle.
Typical symptoms*:
- Central chest pain
- Pain or numbness in one or both arms
- Jaw pain
- Back pain
- Shoulder pain
- Nausea
- Sweating/clamminess
- Difficulty breathing
- Some will have a sense of ‘impending doom’, others will try to convince themselves that their symptoms are anything but ACS
٭ Remember, SCAD patients are often younger, more likely to be female and sometimes may have had a recent pregnancy. Atypical symptom presentations are more common in this patient population so consider a lower threshold for further investigations in hospital.
![Heart attack pain locations](/images/SCAD-graphics/Heart-attack-pain-positions-male-and-female-Beat-SCAD-colours.jpg)
Please consider the risk of conscious and unconscious bias in your patient profiling. Most SCAD patients have classic Acute Coronary Syndrome (ACS) symptoms but may not look like a traditional ACS patient. Specifically, although they may have some traditional risk factors (eg a history of high blood pressure), SCAD patients will often have a lower risk profile than atherosclerotic heart attack patients.
SCAD facts…
- ~90% female, about 10% male
- Most are young to middle-aged, average age around 50 (but SCAD has been reported in patients aged 18-84)
- All ethnicities may be affected
- Pregnant/post-partum – 10% of cases of SCAD overall but SCAD accounts for 21-27% of heart attacks in pregnancy
- 50% of post-partum coronary events are reportedly due to SCAD
SCAD patient experiences: Treat the symptoms not the profile
Remember to treat the symptoms you see in front of you – not the patient's risk profile – and please check your bias. SCAD patients tell us that because they often have few/no cardiac risk factors:
- They get told they have indigestion or are having a panic attack when they are, in fact, mid heart-attack.
- Male SCAD patients are often treated like patients with atherosclerosis.
- Many patients get asked if they have recently used cocaine…
- Pregnant or post-partum patients are told they’re ‘too full of hormones’ to be having a heart attack.
Paramedics – actions in the case of suspected SCAD:
- Undertake ECG (may be normal)
- Triage to a cardiac centre and transport with pre-alert
- Advocate for patient on handover and reinforce the need for troponin testing*
* remembering receiving teams may be unfamiliar with SCAD and elevated troponin may be the only early diagnostic indicator
A&E Staff – check Troponin levels
- Perform promptly and then repeat a Troponin blood test according to local protocols for ACS. Explain that it is best to stay in hospital until the results are back.
Cardiology Staff – take care when performing angiograms
- Check Troponin results
- Angiograms (see the chapter on SCAD in The PCR-EAPCI Textbook)
- necessary to confirm diagnosis but consider stability of patient before performing
- gentle catheter technique essential
- low threshold for OCT imaging where diagnostic uncertainty remains after initial angiography
- conservative management optimal if patient is stable
- if stenting required, expect more complications than for patients with atherosclerosis
- avoid repeat angiograms unless patient is unstable (and never to ‘check for healing’)
- CT coronary angiography (CTCA) has a high false negative rate in SCAD patients. Normal CTCA does not exclude SCAD
- not sure of the diagnosis or best management? Diagnosis can sometimes be difficult. Clinicians, please contact the Leicester SCAD service (Dr Adlam) directly 24/7 via Glenfield Hospital switchboard or the SCAD email scad@uhl-tr.nhs.uk
- In-hospital monitoring
- Where conservative management fails, the majority of recurrent SCAD cases occur during early follow-up, so monitoring in hospital for at least five days is advised in conservatively managed SCAD patients.
SCAD Patients
If you have had a SCAD and think you are having another one or suspect you or someone you are with is having a SCAD, don’t ignore cardiac symptoms.
- Don’t delay: time = heart muscle
- Check: Symptoms of a heart attack on the NHS website
- Dial 999: state “suspected heart attack”, describe symptoms
- Time to go: get the patient to a cardiac centre
- Troponin blood test required (see FAQ on Symptoms and Diagnosis page for more information about Troponin tests)
- Share our SCAD for health professionals leaflet and this page with any healthcare professional you talk to