Coronary artery dissection

The macro tools were just blind to the micro failure.

OK, the slide also lists unique pathologies, SCAD and Takotsubo.

Let's start with the SCAD, spontaneous coronary artery dissection.

This strikes young, healthy women with zero risk factors, right? What physically happens?

There's no lipid plaque at all.

Oh my god.

Yeah.

Unless they are crashing in shock, the treatment for SCAD is highly conservative medical management.

She's spoken openly about mental health.

More recently, she's revealed that she suffers or suffered a SCAD heart attack at the age of 40.

Libby and her husband Luke are raising five children.

She continues to use her experiences to help others both in and out of the water and the sporting world.

That's fantastic.

I want to ask you about the serious matter.

You thought you were having a panic attack, but it turns out you'd suffered something called a SCAD heart attack.

And you've been really open about this and that helps people because hearing it from, as you know, someone like you doesn't quite normalise it, but it almost does.

Yep.

And we also know about the prevalence of things like SCAD, which is spontaneous coronary artery dissection.

You can have that postpartum as well.

So that comes without any other symptoms.

But it's also important to recognize that there's specific types of heart attack that predominate in women.

So there's a type of heart attack called SCAD.

It's called spontaneous coronary artery dissection.

It's not related to cholesterol plaque buildup but rather a sudden tear or bleed inside the heart artery wall, and this can occur in women in their 30s, 40s, and also during pregnancy and postpartum.

We actually talked to Libby Trickett, uh, the Olympic swimmer-

Mm

... about her SCAD heart attack a couple of months ago.

You can scroll back through the Life Matters feed to find that one.

And when those mast cells detonate, the physical consequences for the maternal blood vessels are terrifying.

The sources bring up an acronym here, SCAD.

Spontaneous coronary artery dissection.

This is a highly lethal non-atherosclerotic cause of heart attacks that disproportionately affects women in the peripartum period.

And by that, I mean we no longer have the numerical classification from the fourth universal definition of MI.

That's been replaced by a more streamlined and, uh, more clinically relevant, um, classification that includes primary myocardial infarction, that includes the typical plaque rupture, atherothrombosis myocardial infarction that we're most commonly seeing in practice, but it includes all the other causes of acute coronary pathology that could cause a heart attack, and that includes things like embolism to a coronary in the setting of atrial fibrillation or spontaneous coronary artery dissection, or SCAD, um, that's more common in women.

Then we have secondary myocardial infarction, and secondary myocardial infarction simply means a heart attack that occurs in the setting of another acute medical illness.

So think of something like atrial fibrillation with a rapid ventricular response in somebody with underlying coronary disease, and their cardiac biomarkers go up.

And the reason that's important is that we know women have lower levels of cardiac troponin than men do at baseline, and if we don't use sex-specific levels, we run the risk of under-diagnosis in women.

So very important that we, we are really recommending the sex-specific thresholds.

The other thing I think that's relevant to women is, as we know, SCAD occurs more commonly in women, and we'll now for the first time really be able to understand, um, SCAD and its incidence within this diagnosis.

And so finally, I think the other important thing that we have done is we've worked closely with the World Health Organization to develop ICD-11 codes, diagnosis codes, that will link directly to spontaneous myocardial, or primary myocardial infarction, the spontaneous types that we're used to, STEMI, non-STEMI, and the variants thereof, as well as secondary myocardial infarction and procedure-related myocardial infarction.