Dr. Rajeev Pillai, IRMC’s interventional cardiologist, has during his three years at IRMC diagnosed several cases of Spontaneous Coronary Artery Dissection (SCAD) an uncommon but emergent condition. SCAD occurs when a tear forms in a blood vessel in the heart. Affecting mostly women in their 40s and 50s, though it can occur at any age and in men, patients with the condition report symptoms of a heart attack.
While research is ongoing to understand why SCAD presents, the condition is found to be not as rare as originally thought. Findings are developing that 1% to 2% of heart attacks are actually SCAD. Awareness is focused on educating young women to seek care if they have symptoms of a heart attack, especially women who recently gave birth, when there is a higher incidence of SCAD.
On July 20, 2019, Kitty Henry presented to IRMC. Kitty was engaging in her usual hour-long spin class when halfway through she just wasn’t feeling her usual self. She got up “and as women do, I cleaned off my bike and left the class early,” she recalls.
“Sitting in my car, I was deciding whether to call my husband, Dana, or to drive to the Emergency Department. I decided to go home.”
Once home, Kitty laid down on the sofa and was checking her heart rate on her Fitbit. The couple then made the decision to go to IRMC’s ER. From there, things happened quickly. At one point, Kitty remembers seven staff members in her room. She was in awe of how they each knew their role and worked well as a team. Dr. Pillai came to the ED and told her she was going to the cath lab for a cardiac angiography.
Post angiography, Kitty was diagnosed with SCAD. She had no blockage in the first third of the main arteries but, more importantly, Pillai found an angiographic finding in the blood vessels in her legs that is classically associated with SCAD.
“Bringing these two together I diagnosed her with SCAD,” Pillai said.
Pillai sent Kitty to the Mayo Clinic, which has established a clinic for genetic investigation to identify mutations (defects in the genetic blueprint) that cause SCAD; in other words, spontaneous tears in blood vessels that supply the heart. Some mutations may be inherited from a parent without an apparent blood vessel problem, while others may develop for the first time in the affected person.
Kitty underwent three days of testing at the Mayo Clinic. Dr. Hayes from the Mayo Clinic confirmed the SCAD diagnosis, and told Kitty that everything done at IRMC was what should have been done.
Kitty still partakes in the study, mostly done by filling out questionnaires via email.
Pillai states it is important to educate the patient about SCAD, what it means and what the issues are because there is a 20% recurrence within about six years. After a diagnosis of SCAD, it is important if presenting to an ED with chest pain symptoms to alert the staff because the treatment is totally different than the treatment for a heart attack.
Kitty, her daughter, Lauren Williams-Klinefelter, and husband, Dana, continue to educate themselves on the disease. While data is still being solicited to determine if SCAD is inherited, Kitty knows her mother suffered from tears in her arteries. Lauren, having a mildly elevated blood pressure, consulted with her family physician and was started on a mild dose of blood pressure medication because of her mother’s diagnosis.
Kitty was back to her position at the Indiana Gazette within 3½ weeks from her diagnosis. She is aware of the recurrence rate and has modified her lifestyle. Lawn work was a great enjoyment and that is now off the table, as is spin class. Kitty still participates as a member of the YMCA but her workouts are modified.
“I definitely follow the rules,” she says. “I still enjoy life.”