It is widely known that the most common cause of a heart attack is fat buildup in the arteries (atherosclerosis). However, for pregnant women, atherosclerosis contributes to only one-third of their heart attacks.
Spontaneous coronary artery dissection (SCAD) is rare among the general United States population, but cardiologists have expressed they are noticing an increase in reported cases. They have also found that pregnant women (whether peripartum or postpartum) face the highest risk. SCAD most frequently occurs near term or within three months postpartum. What is most alarming is that the condition can occur in otherwise perfectly healthy women with no previous cardiac risk factors such as diabetes, high blood pressure, or high cholesterol levels. Tragically, 80 percent of cases occur in women and many die before receiving medical help.
Coronary Arteries
The human heart has two coronary arteries: the left coronary artery and the right. They are the relatively narrow vessels that carry oxygen-rich blood to the heart muscle (myocardium) itself.
How does a SCAD occur?
A tear develops inside of a coronary artery, which allows blood to create a split between the two layers of the wall. This could then result in a loose flap of tissue on the inside of the artery or a blood clot in the damaged artery and surrounding areas. This can block blood flow and potentially cause a heart attack.
Why Does SCAD Happen?
Recent evidence suggests the condition is often related to female hormone levels. It is also suspected that the combination of hormonal changes added to the stress of childbirth could weaken a woman’s heart muscle. An excess of progesterone is thought to cause structural changes to the vessel wall resulting in a greater risk of a dissection.
Symptoms
Symptoms are usually very similar to those of a heart attack. Survivors have described symptoms such as severe central chest pain and numbness in arms.
Some symptoms of pregnancy-related heart problems include:
- fatigue
- feeling of racing heart or skipping beats
- increased nighttime urination
- shortness of breath
- swelling
Expectant or new mothers with those signs should tell their doctors immediately.
Diagnosis
A coronary angiography is performed as urgently as possible following the cardiac episode. A coronary angiography involves releasing a special dye consisting of contrast material (via catheterization) into the bloodstream, which then makes the coronary arteries visible to the eye on X-rays. The X-rays allow doctors to see how blood is flowing through the patient’s heart.
If an abnormality is found, it usually indicates the patient has a blocked artery. This confirms the diagnosis and assists in determining the best therapeutic strategy for treatment. The therapy selected is mostly based on the clinical presentation, the progression of the dissection, and the amount of risk the myocardium faces.
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