Always On EM - Mayo Clinic Emergency Medicine

Chapter 47 - Hidden Killer of the Healthy - An "Intimal" Discussion of Spontaneous Coronary Artery Dissection

Nov 1, 2025
Guest
Dr Marysia Tweet
Guest
Sharonne Hayes
Dr. Sharonne Hayes, a leading expert in sex- and gender-based cardiovascular care, and Dr. Marysia Tweet, co-leader of the SCAD Registry, discuss the often-missed diagnosis of Spontaneous Coronary Artery Dissection (SCAD). They highlight how SCAD can occur in healthy, active young people and describe its complex presentation, including atypical chest pain and low initial troponin levels. The conversation covers diagnostic pitfalls, treatment approaches, and the importance of compassionate care in recognizing this hidden heart risk.
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INSIGHT

SCAD Was Historically Missed

  • SCAD was long under-recognized because clinicians expected visible intimal flaps and missed intramural hematomas.
  • About 70% of SCADs are intramural hematomas, explaining historical underdiagnosis on angiography.
ANECDOTE

Mayo’s Early SCAD Series

  • Early Mayo review of 87 patients found survival, recurrence, and large association with fibromuscular dysplasia.
  • They also observed higher PCI complication rates and vessel healing without intervention.
ANECDOTE

SCAD Affects Young, Fit Patients

  • Mayo Clinic registry includes patients as young as 17 and even college students with SCAD during activities like skiing.
  • Many SCAD victims are active, fit women who do not fit classic MI stereotypes.
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