Pregnancy-Associated SCAD: What You Need to Know

Heart attacks during pregnancy are rare. But when they occur, they’re often caused by pregnancy-associated spontaneous coronary artery dissection (P-SCAD). This life-threatening condition happens when a tear develops in a coronary artery wall, blocking blood flow to the heart.

Nandita S. Scott, MD, a Mass General Brigham cardiologist and director of the Women’s Heart Health Program, describes what causes P-SCAD and whether it’s safe to get pregnant again.

What is P-SCAD?

P-SCAD is a form of spontaneous coronary artery dissection (SCAD) that occurs during or within the first year after pregnancy. In SCAD, a tear develops in the wall of a coronary artery. Blood accumulates between the layers of the artery wall, which expands and reduces blood flow to the heart muscle. The lack of blood flow results in a heart attack.

Most instances of P-SCAD occur the week after delivery, but it can happen during pregnancy.

P-SCAD can be life-threatening for both mom and baby. In severe cases, the reduced blood flow can cause shock, a dangerous condition where the body’s organs and tissues don’t get enough oxygen-rich blood.

Symptoms of P-SCAD

P-SCAD shares the same warning signs as typical heart attacks. Seek emergency medical help if you experience any of the following symptoms:

• Chest pain or pressure
• Dizziness
• Extreme fatigue
• Nausea
• Pain or discomfort in the neck, back, jaw, arms, or shoulders
• Rapid heartbeat
• Trouble breathing

Why does P-SCAD develop?

Experts are still unclear on what causes P-SCAD. Unlike typical heart attacks caused by plaque that builds up over years, P-SCAD involves a sudden tear in the artery wall.

Different factors during pregnancy may contribute to this, including hormone fluctuations. “The hormones that are secreted to help deliver the baby and support pregnancy have the effect of weakening our arteries,” Dr. Scott says. Weaker blood vessels are more vulnerable to tearing.

In addition, pregnancy forces your heart to work harder to pump blood to you and your baby. The added strain puts more stress on the blood vessel walls, which can make them more likely to tear.

Dr. Scott says you may also be more susceptible to P-SCAD if you have:

• Given birth multiple times
• High blood pressure during pregnancy (preeclampsia)
• Taken fertility treatments

How is SCAD diagnosed?

When someone arrives at the emergency room with a heart attack, doctors typically conduct:

• An electrocardiogram (ECG) to measure changes in electrical activity in the heart
• Blood tests to check for heart proteins that leak into the blood because of heart damage

Depending on the results, your health care provider may perform an angiogram. This is the gold standard test for diagnosing P-SCAD, Dr. Scott says. It involves injecting dye into the blood vessels and taking images with an X-ray-type machine. The images show how blood circulates and identify any blockages or tears.

Treatment for P-SCAD

“The good news about P-SCAD is that the artery typically heals within 4 weeks,” Dr. Scott says. You may only need medicines to treat symptoms and restore blood flow. These may include aspirin and beta-blockers, which help manage blood pressure.

Once the heart has healed, your doctor may recommend participating in a cardiac rehab program. This involves monitored exercise, as well as emotional support. Data shows nearly half of patients develop post-traumatic stress disorder related to SCAD.

In some cases, the tear won’t heal on its own. If that happens, you may require intervention to restore blood flow to the heart muscle.

Is it safe to get pregnant again after getting P-SCAD?

In the past, doctors advised against future pregnancies for women with P-SCAD. “If you had it and you get pregnant again, that subsequent pregnancy might be risky,” Dr. Scott says. You may be more likely to get P-SCAD again.

However, it may be possible to have a safe pregnancy after P-SCAD. It’s best to discuss your options with a specialist. “Generally, we take it on a case-by-case basis,” Dr. Scott says. In the meantime, use a reliable method of birth control.

Having a multidisciplinary care team like those at Mass General Brigham helps ensure a safer pregnancy. Your care team may include a cardiologist, a maternal-fetal medicine specialist, a rehabilitation specialist, and others. They coordinate your prenatal and postpartum care to keep you and your baby healthy.