40% Of Heart Attacks In Women Under 50 Are Due To This Condition You’ve Never Heard Of

40% Of Heart Attacks In Women Under 50 Are Due To This Condition You’ve Never Heard Of

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By Karen Cicero

You’re 35. Fit. Normal blood pressure and cholesterol. So there’s no way that chest tightness you’re feeling could be a heart attack, right? Not necessarily. “The number one cause of heart attacks in women under 50 has nothing to do with cholesterol levels, weight, or fitness habits,” says Alfred Casale, MD, chair of cardiothoracic surgery at Geisinger Health System in Danville, PA. “In fact, if you looked at a scan of the person’s arteries the day before their heart attack, you might say, ‘They look great.'”

The sneaky culprit of heart trouble in the 20- to 40-something age range is called SCAD—short for Spontaneous Coronary Artery Dissection. It happens when the innermost of the three layers of arteries supplying the heart with blood tears out of the blue, causing a clot or flap that can narrow or even block blood flow. Casale supplies 4 important facts every woman need to know about SCAD:

While SCAD can happen to anyone, 80% of sufferers are women, and 30% of SCAD heart attacks occur in the third trimester of pregnancy or soon after delivery. “We think hormonal changes late in pregnancy that help loosen the tissues in the birth canal for delivery also affect the blood vessels in the heart too in some women,” he says.

People with connective tissue disorders, especially noncoronary fibromuscular dysplasia, also have a greater chance of suffering from this type of heart attack. In fact, one study of 116 SCAD patients at the Mayo Clinic found that 44% of them had this disorder. And being young doesn’t protect you: The average age for a SCAD heart attack is 42—that’s well below 70, the average age for women’s heart attacks overall.

Signs of SCAD don’t differ from a typical heart attack, which is caused by a build-up of plaque. But, in general, women of any age experience subtler heart attack symptoms than men, says Casale. “Think more like chest discomfort or tightness than crushing pain. The pain could also be in your jaw, shoulder, or arm,” he says. If you have these symptoms, don’t hesitate to go to the ER because time is of the essence. “If we can get an artery open within 90 minutes, you have a much better chance at getting back to full speed,” he says. That’s because heart muscle can deal with not having enough blood for about an hour and half—after that, it starts to die.

You’ll get blood tests in the ER to determine if you’re having a heart attack. “Whether the heart attack is caused by the usual plaque or SCAD, the tests will pick it up,” assures Casale. From there, you’ll likely be transported to the cardiac catherization lab. That’s where doctors will be able to tell what caused your blockage. If it’s plaque, chances are you’ll receive a stent—a wire mesh tube that props open an artery. But if it’s SCAD, a stent may do more harm than good. “Stents are effective 90 to 95% of the time for a heart attack caused by plaque, but only 60 to 70% of the time for a SCAD heart attack because the tissue is more fragile,” Casale says. Your doctor will make the judgment call as to whether to go the stent route or treat your blockage with blood thinners alone.

You can stop freaking out. Even though SCAD is the top cause of heart attacks in women under 50, thankfully heart attacks in this age group just aren’t all that common overall. For instance, the risk of a 35- to 44-year-old white woman having a heart attack is 1 in 5,000, and it’s about 1 in 1,000 for African American women, according to the American Heart Association. Still, “the thing I want women to remember is if something doesn’t feel right in your chest, get it checked out,” says Casale. “Emergency-room doctors would much rather send home a patient than miss a heart attack.”

This article was originally published in Prevention on March 1, 2017.

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40% Of Heart Attacks In Women Under 50 Are Due To This Condition You’ve Never Heard Of