Symptoms & Diagnosis

SCAD patients experience different symptoms; the most common are:

• Central chest pain
• Pain or numbness in one or both arms
• Jaw pain
• Back pain
• Shoulder pain
• Nausea
• Sweating/clamminess
• Difficulty breathing

It’s important that a diagnosis of SCAD is not delayed. The sooner a diagnosis is made, the better the outcome is likely to be. The longer blood flow is reduced, the higher the chance of permanent damage to heart muscles.

Tests to diagnose heart attacks and SCAD include:

• ECG (electrocardiogram) – although ECGs can look normal in some SCAD patients 
• Blood tests to assess Troponin levels. (Troponin is a protein that is released into the blood during a heart attack – read more in the FAQ below)
• Angiogram
• CT scan

You may also be given an Echocardiogram which shows how well the heart is functioning and what your Ejection Fraction is (see FAQ below for more). 

Current best practice  is that patients should be monitored in hospital for at least five days because the majority of recurrent SCADs occur during early follow-up.

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

Troponin is a protein that is released into the bloodstream during a heart attack. Raised Troponin blood test results are often part of the process that leads to a SCAD diagnosis. Raised troponin levels, together with other heart attack symptoms, should result in a request for an angiogram to confirm the diagnosis.

Troponin levels in the blood typically increase within 3-12 hours from the beginning of chest pain, peak at 24-48 hours, and return to their baseline over 5-14 days.

Measurement of Troponin levels for patients with chest pain in A&E has been studied widely. Baseline measurement of troponin levels, followed by serial measurements of troponin three hours afterwards, should be performed. Both the absolute value of the troponin level as well as the degree of change in the troponin level should be considered.

It is now understood that women may experience a heart attack at a lower level of Troponin in the blood than men. A higher sensitivity Troponin blood test has been developed and is currently being tested. Currently this is not available at every A&E.

We asked SCAD expert Dr David Adlam if SCAD always causes a heart attack? He told us: It depends on definitions – the overwhelming majority of SCAD patients will present with an acute event (sudden onset) and there will be a rise in the cardiac enzymes which are an indicator of a heart attack. There are some patients who don’t seem to have a rise, but in most cases the patients’ presentation is some time after the event. In this cardiac MRI study, there were 40% of patients where there was no demonstrable injury in terms of a scar. So many of the patients who have the smaller event will not have a persisting heart injury of any size that will be important going forward in terms of the heart function. 

Ejection fraction (EF) refers to how well the left ventricle (the heart’s main pumping chamber) pumps blood with each heart beat. Most times, EF refers to the amount of blood being pumped out of the left ventricle each time it contracts.

Your EF is expressed as a percentage.

• 55-70% is considered normal
• 40-54% the pumping ability of your heart is considered slightly below normal, but you may not have any symptoms
• 35-39% the pumping ability of your heart is considered moderately below normal and you may have mild heart failure
• less than 35% the pumping ability of your heart is considered severely below normal and you are likely to have moderate to severe heart failure

SCAD patients should note that Ejection Fraction measurement is not an indication of whether your SCAD has healed or not. EF is often checked during an echocardiogram at the time of the SCAD and then later (6-12 months after the SCAD). Any improvement seen in the overall results of a follow up echocardiogram can be viewed as signs of the SCAD healing process. Ejection Fraction has regularly been seen to improve in SCAD patients over time, particularly after use of appropriate medications and lots of rest to allow the heart to heal.

Click on the links below for more information about Ejection Fraction and Heart Failure.

Cleveland Clinic

NHS information on heart failure

BHF information on heart failure

Migraines happen with increased frequency in SCAD patients. The GWAS (Genome Wide Association Study) on SCAD, published in 2023, identified 16 genetic variants that confer a higher risk of having a SCAD, but it is not caused by a single gene in the same way hereditary diseases are. These genetic variants can be likened to the 'hand of cards' we're dealt at birth (our genetic make-up) – each person will have a different combination of many common variants and it is this combination that can increase the risk of having a SCAD.

One of these variants, PHACTR1, is associated with the risk of migraine and many SCAD patients have reported suffering from migraines. More research is needed to find out more.

Experts say migraine management can be tried using a range of alternative approaches (including topiramate, riboflavin, magnesium, flunarizine, lamotrigine, amitriptyline and valproate). Please check with your GP or cardiologist before starting, stopping or changing any medication.

Find out more by watching these videos:

Beat SCAD Conference 2023 (from about 25 minutes)

Dr David Adlam explains the findings PHACTR1. 

Dr Adlam explains the findings of the GWAS paper.