Question 1

Should SCAD patients have repeat angiograms to check for healing?

Accepted Answer

Follow-up invasive angiograms to check on healing are not recommended for SCAD patients as there is a small risk of causing dissections with the catheters used during these procedures. However, recent studies show that virtually all SCADs heal by themselves between three and six months after the SCAD event. Sometimes, if the SCAD is in the larger parts of the coronary arteries, a follow-up coronary CT scan can be done to confirm healing, but this is not a good option for SCADs that were in smaller arteries as the spatial resolution of CT isn’t good enough to assess this with any accuracy. CT scans involve X-rays (with a small lifetime associated cancer risk) and in patients without symptoms, follow-up scans rarely highlight any important findings. For patients with ongoing chest pain, a stress test (using imaging such as MRI or exercise) can be done to confirm there is no persisting issue with the blood supply to the heart.

Question 2

What can cause chest pain?

Accepted Answer

There are a number of causes for chest pain. This article from the BHF explains more.

Question 3

Is ongoing chest pain after SCAD normal?

Accepted Answer

Ongoing chest pain is common among SCAD patients during the first year or so. 60-90% of SCAD patients experience recurrent chest pain after SCAD (Post-SCAD Chest Pain Syndrome), according to studies referred to in the European Position Paper on SCAD. Complete the Download form on this page to request Beat SCAD’s summary of the European Position Paper. Hospital readmission for chest pain after SCAD is also very common. Given the risk of recurrence (circa 10%), it is recommended that ECG and Troponin blood tests should always be done. In some patients the pain is cyclical, usually pre-menstrual. Anecdotally, cyclical symptoms may respond to low-dose contraception (eg the progesterone hormonal ‘Mirena Coil’). For those who get non-cyclical spasm-like pain, vasodilator treatments may reduce vasospasms. While the cause of post-SCAD chest pain is not fully understood, SCAD specialists recognise it and have observed that, over time, for most patients, it does get much better. Typically, for most patients, it will have faded into the background by 24 months (much sooner for many). However, a small number (much less than 10%) continue to experience chest pains longer than that. Watch Dr Adlam talk about this here (starts at 34 minutes) and here (starts at 42 minutes). Keeping a journal of symptoms (physical and mental) and feelings may help us to spot triggers for the chest pain. Common triggers include dehydration, tiredness, doing too much too soon, doing something physical for the first time after our SCAD – eg vacuuming, hanging out washing, carrying heavy shopping etc. A journal is helpful for medical appointments recapping key events and dates etc.  Also for illustrating that eventually the bumps in the road get smaller and spaced further apart…. Click here for more information about Chest Pain after SCAD.

Question 4

What medications are prescribed for SCAD patients?

Accepted Answer

Most SCAD patients are given medications used to treat plaque-related heart attacks, including antiplatelet medication such as aspirin and clopidogrel, blood pressure medication, betablockers and statins. Complete the Download our Leaflets and Jargon Buster for on this page to request our Jargon Buster for an explanation of what these medications do. More research and clinical trials are needed to identify the best treatments, however Dr David Adlam, who is leading the UK SCAD research, discusses the current thinking in this video.

Question 5

Cholesterol and SCAD - do I need to take a statin?

Accepted Answer

Lead UK SCAD researcher, Dr David Adlam told us the following:. From what is currently known, SCAD is not a cholesterol-driven disease process (unlike con-ventional heart attacks which are caused by atherosclerosis). Most patients should therefore be considered as if they have not had a heart attack. Doctors call this ‘primary prevention’ (whereas secondary prevention is where patients are treated after an atherosclerotic vascular event such as a conventional heart attack). This means it is reasonable to use the lower doses of statins generally used for primary pre-vention, when applicable, rather than the higher doses used for secondary prevention. There are a few ‘exceptions’, including patients who have bypass grafts (particularly vein grafts) or long sections of stenting. This is because we worry these might be at risk of accel-erated atherosclerosis over the long life-expectancy of SCAD. We therefore sometimes err on the side of treatment in these cases. There are also a few cases of SCAD where we see con-ventional coronary disease as well as SCAD (this is more unusual as the genetics of SCAD protects a bit against atherosclerosis). Again we might err here on the side of treatment. Ultimately all medication, particularly medication targeting risk reduction, is a personal choice. One person may prefer to minimise, even a small risk, while another might prefer not to take a tablet, even for a higher risk. This is the reason I often encourage patients to work through their QRISK3 themselves or with their practice nurse so they can see what their percentage risk is and use this to guide their decision-making.

Question 6

Is cardiac rehab recommended for SCAD patients?

Accepted Answer

Beat SCAD recommends that all SCAD patients should be referred to, and encouraged to participate in, a cardiac rehabilitation programme to aid their recovery. Cardiac rehab is beneficial for all SCAD patients as it will help them gain confidence in their bodies and recognise their abilities and limits. If you have not been offered cardiac rehab, please ask your GP/cardiologist to refer you. A paper published in the European Heart Journal, recommends moderate aerobic exercise, interval training, resistance training using lower resistance and higher repetitions. Patients are advised to be cautious when doing high endurance aerobic training, muscle-building exercises or Yoga poses that involve extreme head and neck positions. They should avoid abrupt high-intensity exercise, contact sports, extreme head positions and exercises involving the Valsalva manoeuvre (holding your breath and straining during lifting of heavy weights). Dr David Adlam, who is leading the UK SCAD research, discusses cardiac rehab and exercise in this video (starts at 17 minutes). Click here for more information about Cardiac Rehab.

Question 7

What exercise should I do after SCAD?

Accepted Answer

A paper published in the European Heart Journal, recommends moderate aerobic exercise, interval training, resistance training using lower resistance and higher repetitions. Patients are advised to be cautious when doing high endurance aerobic training, muscle-building exercises or Yoga poses that involve extreme head and neck positions. They should avoid abrupt high-intensity exercise, contact sports, extreme head positions and exercises involving the Valsalva manoeuvre (holding your breath and straining during lifting of heavy weights). Dr David Adlam, who is leading the UK SCAD research, discusses cardiac rehab and exercise in this video (starts at 17 minutes). Click here for more information about Exercise after SCAD.

Question 8

Why are SCAD patients offered flu and pneumonia jabs?

Accepted Answer

The flu virus can weaken the respiratory system, which the heart relies on. The virus can also attack the heart muscle. Pneumonia can also have long-term consequences on the increased risk of heart attacks and strokes. Many GP surgeries will automatically offer the annual flu jab and the longer term pneumonia vaccination to all heart attack patients. You can also get it from your local pharmacy or (if you are pregnant) your midwife.

Question 9

Can I have dental work after a SCAD?

Accepted Answer

Before you visit your dentist for a check-up, a scale and polish, or for more complicated work, please do let them know about your SCAD, perhaps share our SCAD for healthcare professionals leaflet with them and tell them about any medication you have been prescribed. If you need pain relief for dental work to be carried out after SCAD, do bear in mind that the injection your dentist uses might contain adrenaline. For some SCAD patients this can produce palpitations and other unpleasant symptoms. Dentists can offer adrenaline-free injections if you ask for them. Some dentists may be reluctant to treat a recently diagnosed SCAD patient, mentioning concerns about the possibility of a bacterial infection (for example at the site of a tooth extraction) entering the blood stream that could damage the heart, however there are no official guidelines to say that you should wait a certain number of months after your SCAD before treatment.

Question 10

What is INOCA?

Accepted Answer

INOCA (Ischaemia with Non Obstructed Coronary Arteries) is a collective term for conditions such as: Coronary Microvascular Dysfunction (Microvascular Angina), Coronary Artery Spasm and Takotsubo. Like SCAD, INOCA conditions are often misunderstood and are also frequently under-recognised, under-diagnosed and under-treated. Frustratingly, this sometimes leads to people being told there is nothing wrong with them, when there is. Patient-driven initiatives such as INOCA International hope to speed up research into microvascular angina, as well as help share information currently available regarding diagnosis and treatment of this complex and disabling condition. It is hoped that this important work will also be of help to the SCAD community.

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