Heart condition that puts young women at greater risk sometimes overlooked

Chest pain should not be dismissed in young, fit patients because it could be a symptom of spontaneous coronary artery dissection, which often affects otherwise healthy individuals, a new study says.

Women appear to have a greater risk of developing the condition than do men, said Rajiv Gulati, MD, PhD, lead author of the study published online July 16 in Circulation.

More research is needed to determine the cause of spontaneous coronary artery dissection, he said. But potential factors associated with the condition include fibromuscular dysplasia, extreme physical activity and hormones (the condition was most common in women during the three months after giving birth).

An estimated 800 new cases of spontaneous coronary artery dissection occur in the U.S. each year, the study said. But many other cases go undiagnosed, in part, due to the difficulty of identifying the problem on an angiogram, Dr. Gulati said.

“SCAD is not related to plaque buildup that more commonly causes coronary blockages. It’s a completely different disease process,” said Dr. Gulati, associate professor of medicine in the Division of Cardiovascular Diseases at Mayo Clinic in Rochester, Minn. “The patients are typically young, fit and healthy, and they are blown away by a totally unexpected heart attack.”

Researchers examined medical records of 87 adults who received care at Mayo Clinic in Minnesota between 1979 and 2011 and had angiographic evidence of spontaneous coronary artery dissection.

The mean age of participants was 42.6, and 82% of them were female. Ninety-one percent of the individuals reported having chest pain when they sought care, and 49% were diagnosed with ST-elevation myocardial infarction. About one in 7 participants experienced ventricular fibrillation or ventricular tachycardia and required emergent defibrillation (link).

During follow-up, spontaneous coronary artery dissection recurred in 17% of participants, all of whom were women. The recurrence took place between three days and 12 years after the first event. Three participants died after 10 years, the study said.

The percentage of recurrence “was a lot higher than we expected,” Dr. Gulati said. Because there was no time period during which recurrence was more likely to occur, he encourages physicians to monitor all patients closely who had spontaneous coronary artery dissection.

He also recommends that doctors pay particularly close attention to female patients’ cardiovascular concerns during the first three months after childbirth.

“There’s a very easy tendency to dismiss symptoms during the postpartum period [as side effects] of just having a baby,” Dr. Gulati said. “Maintain suspicion [of spontaneous coronary artery dissection for postpartum patients]. Don’t just dismiss” their symptoms.