SCAD tends to strike healthy, fit adults with no traditional risk factors for heart disease or personal risk factors for atherosclerosis. 90% of patients are women and the average age of sufferers is just 42 to 52 years but it has been described in teenagers and women in their 7th decade of life.

SCAD is the #1 cause of heart attacks among women under the age of 50 years and those who are pregnant or have just given birth. Although less common, SCAD can affect men too. Some SCAD patients have been found to have an underlying blood vessel disorder most commonly fibromuscular dysplasia (FMD).

SCAD patients typically have electrocardiogram (ECG) findings and troponin level elevations consistent with heart muscle cell loss. A diagnosis of SCAD as the specific type of MI is by its typical appearance at the time of a coronary angiogram or, occasionally, by CT coronary angiography. In the case of sudden unexpected death, an autopsy may reveal SCAD. Most people (95%) treated in hospital do very well. However chest pain and recurrent SCAD can recur (up to 30% of cases over a 10 year timeframe).

Although much has been learned about SCAD in the past few years, the cause of SCAD remains obscure and no primary preventive treatment has been identified. After an episode of SCAD, strict blood pressure control and a beta-blocker drug may reduce the chance of a recurrence.

Accurate differentiation of SCAD from other causes of MI is crucial because the approach to acute and long term care is different. Specifically, patients undergoing percutaneous coronary intervention (PCI) for MI due to SCAD have technical success rates that are markedly reduced compared to PCI success rates for atherosclerotic MI (62% vs 92%). Also research has noted a substantial rate of spontaneous vascular healing without intervention and suggests a role for conservative management in stable SCAD patients who have preserved coronary flow. Conservative management usually includes 4-5 days of careful inpatient monitoring. Statins do not appear to prevent another SCAD heart attack and one study found more recurrences in those taking statins. SCAD can recur, so vigilance, evaluation for associated conditions, and staying up-to-date on emerging research is also important.

Source: The medical information on this website has been informed by resources and research from the Victor Chang Cardiac Research Institute and the Mayo Clinic SCAD Study, including findings available in 2026. 

Cardiac rehabilitation is definitely recommended after surviving a SCAD heart attack. Each case of SCAD will be different, however it is generally recommended that SCAD survivors avoid lifting items that require you to strain or bear down. This varies depending on fitness and a person’s build.  Don’t overdo it with exercise – especially avoid isometric exercise, such as weight lifting – but also continue doing what you like, especially if it reduces stress.

More guidelines for cardiac rehab

As patients tend to be healthy, fit, women in their 30s, 40s and 50s with no risk factors for heart disease, experiencing a SCAD heart attack can be a traumatic event.

If patients are experiencing emotional or psychological difficulties after a SCAD heart attack, they contact the Cardiac Counselling Clinic at the Australian Centre for Heart Health, join a SCAD survivor group and take care of themselves while they heal and recover.

A global effort with SCAD studies at the Mayo Clinic, Victor Chang Cardiac Research Institute, in Canada, and in the UK, has gained new insights into associated conditions and treatment approaches. Highlights and significant findings include:

• Extracoronary vascular abnormalities. A high rate of abnormalities in noncoronary blood vessels has been identified in patients with SCAD. These include fibromuscular dysplasia (FMD), aneurysms and additional dissections. Patients with these findings may need additional imaging and follow-up and may be at higher risk of recurrent SCAD.
• Specialised imaging techniques. Mayo researchers are defining the role and value of specialized imaging of the inside of the coronary artery at the time of SCAD to make an accurate diagnosis and guide treatment. The SCAD diagnosis can be missed if only standard coronary angiography is used. The Mayo Clinic SCAD Research Program has demonstrated that advanced imaging techniques such as intravascular ultrasound and optical coherence tomography can not only enhance diagnostic accuracy, but also guide treatment in the crucial early minutes of a heart attack. However they may actually worsen the coronary artery tear, so should be used with caution.
• Complications with stenting. The program team has reported significantly lower success rates and higher complication rates when coronary artery stenting or ballooning is utilised to open artery blockages due to SCAD, compared with rates for patients with typical heart attacks. This has implications for early decision-making for treatment and highlights the need for an accurate diagnosis.
• Selective intervention. Mayo researchers have observed a significant rate of spontaneous healing of SCAD-affected arteries that occurs without specific intervention (medical treatment only). This has led to a change in clinical practice, whereby in select patients with SCAD, clinicians do not intervene with stenting or bypass surgery, but instead allow them time to heal on their own.
• Routine statin use not recommended. Unlike atherosclerotic disease, there is no evidence that statins prevent recurrent myocardial infarction or dissection. Since there is no evidence of benefit, statins should not be routinely given to patients with SCAD, but reserved for those with hyperlipidemia.
• SCAD incidence has been reclassified from ‘rare’ to ‘uncommon’ with increased diagnosis and is the major cause of heart attack in women under age 40 and in pregnant or postpartum women, it is responsible for 35% of heart attacks in women under 50.