It’s Heart Health Month, and all too often, ‘healthy’ women suffer from heart unexpected heart events. What exactly is a spontaneous coronary artery dissection (SCAD), and why should it concern pregnant women?

When you’re pregnant, your body goes through a million different changes. It seems like every cell of a pregnant woman’s body adjusts for the growing babe inside of her, and accommodates to ensure that the baby has all it needs.

This obviously takes a toll on mama, and you can feel it in your joints, your hips, your back, your brain, your ribs, your emotions and just about any other place on and in your body.

But do you know much about your heart health when pregnant?

Heart Disease Risk and Pregnancy

If you’re a newly pregnant mom (or maybe even if you’re not) you most likely know your doctor will be watching for signs of things like gestational diabetes or pre-eclampsia. But is anyone paying attention to your heart?

It’s well-documented that heart disease risk during pregnancy should be considered in assessments. You’re growing another human being, after all, and that’s sure to take its toll on your heart.

But do you know what to look for? What signs of heart issues during and after pregnancy would be? It’s important you do, so that you can keep your doctor informed of any issues that may lend her to better diagnose and treat in the event of a heart issue.

One such condition to note is a spontaneous coronary artery dissection, or SCAD. This is a type of heart attack that happens due to a tear in your artery. A ‘traditional’ heart event or attack will occur due to a blocked artery, not a torn artery. A SCAD heart attack is the number one cause behind a heart attack in pregnant and postpartum women and women under the age of 40.

SCAD heart attacks can happen to both men and women of any age, but about one-third of all SCAD events happen to women who are pregnant or in their postpartum period. This is especially concerning when you think about how little attention is truly paid to a postpartum mother’s health, and certainly her heart health.

It’s also concerning when you look at the research that shows that a woman's cardiac health while pregnant may affect her baby. Poor heart health can impact her baby’s growth and weight at birth, and can even impact the baby’s risk of congenital heart disease or other chronic conditions as they grow.

Pregnancy and SCAD: What You Need To Know

The scary thing about SCAD is that it can strike a woman who would otherwise be considered healthy or who doesn’t present the risk factors that are typically associated with heart conditions. Generally speaking, when you’re pregnant, your doctor or midwife will monitor things like your weight, your cholesterol and your blood pressure. They’ll take your family’s heart health and history into account (often on a surface level, but still, if you have a history of heart disease in your family, it’ll most likely get noted and referred to in the event of alarming physical manifestations).

But SCAD just strikes. A spontaneous coronary artery dissection can strike an otherwise ‘healthy’ woman and researchers believe it could be as simple as pregnancy being taxing and laborious on a woman’s body. Stress and intense physical exercise have been shown to increase risks for a spontaneous coronary artery dissection, and growing a human is a stressful, intensely physical process, as we can best tell.

Sometimes a genetic condition like vascular Ehlers-Danlos syndrome or Marfan syndrome can put you at an increased risk of SCAD. Sometimes conditions like fibromuscular dysplasia or lupus compromise your blood vessels and can put you at an increased risk of a spontaneous coronary artery dissection. If so, it may be wise for you to consult not just your Ob/Gyn or Midwife but a cardiologist as well. Even better if you can find one who specializes in postpartum cardiac care.

Postpartum Heart Conditions And Signs

In an article with Today Parents, Dr. Sharonne Hayes said that the things she most often hears from her patients is that they were doing all the right things—exercise, eating well, staying fit—and still, they had heart attacks. Dr. Hayes is a cardiologist and a lead researcher for the Mayo Clinic SCAD Research in Rochester, NY. She said that 90% of the SCAD heart attack cases are in women, often young and fit with no risk factors. The thing is that SCAD doesn’t have anything to do with lifestyle because it’s a split in an artery—not a blockage caused by lifestyle condition.

Almost all heart attacks involve a blood clot that slows or stops blood flow to the heart. This leads that part of the heart muscle to lose oxygenation and essentially die off. With SCAD, it’s not a blockage but a tear or bleed that causes a bulge in the artery. The effect, however, is the same.

If you suffer from this, you will likely have classic symptoms of a heart attack: chest pressure or pain; radiating pain to your neck, arms or jaw; clammy or sweaty body feelings, shortness of breath, fatigue. You may even go to the hospital fearing something is wrong with your heart. The problem is that many doctors won’t recognize it as SCAD, particularly in a younger, healthier woman or a postpartum woman whose similar symptoms may mimic something else. This is why knowledge about SCAD and signs is important—sometimes we’re the ones educating our caretakers.

It’s also important to know how it’s diagnosed. A typical heart attack can be diagnosed through an electrocardiogram and blood work. Doctors are looking for blockages, generally speaking. Because SCAD is not a blockage, it most likely requires diagnosis with an angiogram or specialized CT scans that either utilize cardiac catheterization or IV dye injections.

And that’s why the problem with diagnosing in younger, fit women or pregnant/postpartum women exists. The diagnosis process is not generally quick or easy, and insurance companies often balk at the thought.

Sadly, symptoms of SCAD also mirror those of peripartum cardiomyopathy, which is also often underdiagnosed and can be fatal. For women who are pregnant and have fluctuating hormones, or postpartum and may be suffering from postpartum depression, the same symptoms may occur. Doctors may simply write them off as such, and you may be at risk.

The bottom line is that any chest pain is abnormal, and if you’re pregnant or recently given birth, you are at an increased risk of heart conditions that could be fatal and should be treated as such.

Treatments For SCAD After Pregnancy

Because SCAD heart attacks are not blockages, but tears, traditional treatments like stents in arteries are not necessarily the best course of action. Dr. Hayes says that the majority of SCAD tears heal on their own within weeks, so conservative treatments are the way to go. Sometimes, though, a stent or an emergency bypass operation may be needed.

The recurrent risk for SCAD after pregnancy is high, and a reason that many cardiologists will warn about subsequent pregnancy after you’ve been diagnosed. The average heart is typically able to handle the heart changes in blood volume, rate and blood pressure during pregnancy, but not always. Dr. Hayes said that SCADS occurring in pregnancy-related situations is more severe.

So it’s important that you find time to relax and destress. Any additional stress you put on your heart during or after pregnancy may contribute to SCAD so it really is important for you to find the time for yourself. Continue to manage your cholesterol and blood pressures so you’ll know when something is just not right. Too often a woman may go in without a baseline blood pressure or cholesterol level and warning signs are missed.

Most importantly, take any of the symptoms seriously. We’re conditioned to second-guess ourselves and to take the ‘most sensible’ answer from our clinicians. While that makes sense, it also means that many things are overlooked because the ‘odds are’ it’s not whatever it is you’re suspecting.

That’s great for you if you’re in the category of ‘odds are NOT…’ but if you’re one of the 1/3 SCAD heart attacks happen to? It’s a totally different story. Never be concerned about being informed and wanting doctors to prove you wrong. It could be the difference between your life and death.

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