Emotional stress and fibromuscular dysplasia are major triggers for spontaneous coronary artery dissection (SCAD), a condition doctors once considered rare. It turns out, this tear in the lining of an artery that supplies blood to the heart is responsible for one third of heart attacks in women under 60 years old, according to new findings presented at the European Society of Cardiology (ESC) Congress 2018, reports the ESC.

Such a rip in one of the heart’s blood vessels can cause the artery to narrow, which restricts blood flow. Symptoms include, but are not limited to, chest pain, rapid heartbeat, shortness of breath and pain in the arms, shoulders or jaw.

For the study, researchers examined the clinical presentation, natural history, treatment and outcomes of SCAD in 750 patients who suffered an acute incident of the condition. (Scientists plan to follow participants for three years to assess any major adverse cardiovascular events.)

Thus far, researchers have noted baseline characteristics and outcomes inside hospitals and at one month. Scientists found that prior to the SCAD event, about 49 percent of patients experienced emotional stress while 30 percent reported undergoing physical stress.

Findings showed that 40 percent of participants presented with fibromuscular dysplasia, the most common predisposing condition for SCAD. This condition causes abnormal cell development in the arteries, which can lead to narrowing or tearing of these blood vessels or to a bulging of an artery, also know as an aneurysm.

Furthermore, all patients who had an acute SCAD event experienced an acute coronary syndrome (99.3 percent had a heart attack and 0.7 percent had unstable angina). (“Acute coronary syndrome” is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart.)

“Our study shows that SCAD primarily affects middle-aged women and most acute presentations occur at the same time as a heart attack,” said Jacqueline Saw, MD, a clinical associate professor of medicine at the University of British Columbia in Vancouver, the study’s principal investigator. “The vast majority of patients survived to 30 days with medication alone. However, recurrent heart attacks and emergency room visits were high within 30 days.”

Shaw stressed that more research is needed to determine the most appropriate treatment for patients with SCAD.

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