Heart Attacks in Young Women Often Misdiagnosed, Linked to SCAD
Heart attacks are often associated with older individuals and those with established cardiovascular risk factors. However, a growing body of research highlights a concerning trend: an increasing number of heart attacks in younger women are being caused by a less-understood condition called spontaneous coronary artery dissection (SCAD) and are frequently misdiagnosed. New data presented at the EAPCI Summit 2026, along with findings from several studies, are shedding light on this critical issue.
SCAD is an emergency condition where a tear develops in the wall of a coronary artery. Blood collects between the layers of the artery wall, forming a hematoma that restricts blood flow to the heart, potentially leading to a myocardial infarction, commonly known as a heart attack. Unlike traditional heart attacks caused by atherosclerosis – the buildup of plaque in the arteries – SCAD often affects women with few or no conventional risk factors for heart disease.
A Distinct Cause, Often Overlooked
For years, SCAD was considered a rare occurrence. However, awareness is growing, and research suggests it may be responsible for a significant proportion of heart attacks in women under 65. A study published in the Journal of the American College of Cardiology found that more than half of heart attacks in women under 65 were caused by factors *other* than clogged arteries, with SCAD being a prominent contributor. This contrasts sharply with heart attacks in men, where clogged arteries remain the most common cause.
“SCAD was considered rare but awareness of the condition is growing,” explained Prof. Svetlana Apostolović from the University Clinical Center Nis, Serbia, whose team conducted a prospective Serbian registry. “SCAD still remains under-diagnosed and under-studied with few, if any, randomised trials conducted to define the most appropriate treatment approach.”
Challenges in Diagnosis and Treatment
The under-recognition of SCAD presents significant challenges for both patients and healthcare providers. Because it doesn’t fit the typical profile of a heart attack, it can be easily misdiagnosed, leading to delays in appropriate treatment. The mechanisms driving heart attacks after SCAD differ from those caused by atherosclerosis, yet treatment approaches have historically been similar. This discrepancy underscores the need for more research to determine the most effective management strategies for SCAD.
Prof. Apostolović’s team followed 123 patients over four years and developed new treatment recommendations. Their findings suggest that stent implantation, a common treatment for atherosclerosis-related heart attacks, may not be beneficial for many SCAD patients. In fact, the Serbian registry showed a complete healing rate in 62.2% of young women with SCAD.
The study identified that SCAD most frequently occurred in women who were not pregnant and in those experiencing menopause. Importantly, the research indicated that SCAD often resolved on its own, and stent implantation was not advantageous for the majority of patients.
Identifying Triggers and Improving Outcomes
While the exact causes of SCAD are still being investigated, research points to both physical and emotional stress as potential triggers. The average age of women in the Serbian registry was 47.5 years, with 6.7% being pregnant or having recently given birth, and 36.2% experiencing perimenopause. This suggests hormonal fluctuations may play a role in some cases.
Effective management of SCAD requires a comprehensive approach that goes beyond acute intervention. Careful monitoring, blood pressure management, cardiac rehabilitation, and psychological support are crucial for long-term recovery and minimizing the impact on daily life. A personalized approach to care, tailored to the individual patient’s circumstances, is essential.
The Importance of Further Research
The European Society of Cardiology (ESC) is currently undertaking a large, multinational SCAD registry to gather more data and improve understanding of this complex condition. This registry, along with ongoing research efforts, aims to refine diagnostic criteria, identify optimal treatment strategies, and ultimately improve outcomes for women affected by SCAD.
The growing awareness of SCAD and the ongoing research efforts offer hope for improved diagnosis, treatment, and support for women experiencing this often-misunderstood and devastating condition. Recognizing the unique characteristics of SCAD is crucial for ensuring that young women receive timely and appropriate care, potentially saving lives and improving their long-term health.
Sources:
Adlam D, Alfonso F, Maas A, et al. (2018). European Society of Cardiology, Acute Cardiovascular Care Association, SCAD study group: a position paper on spontaneous coronary artery dissection. Eur Heart J. 2018; 39:3353–336.
EurekAlert.org (2026). New data on spontaneous coronary artery dissection (SCAD) – a common cause of heart attacks in younger women. Reports and Proceedings.
