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PubMed This is a summary of 22 peer-reviewed journal articles Updated
Cardiology · Spontaneous Coronary Artery Dissection

Building Your Care Team and Essential Screenings

At a Glance

After SCAD, care often includes a cardiology team familiar with SCAD and imaging of arteries from the head through the pelvis to look for fibromuscular dysplasia, aneurysms, dissections, or narrowing. Genetic counseling and pregnancy specialists may be appropriate in selected cases.

Because Spontaneous Coronary Artery Dissection (SCAD) is a unique condition that differs fundamentally from traditional heart disease, your recovery depends on having a care team that understands these nuances. While your local cardiology team is crucial for urgent and routine care, consulting a center or clinician experienced in SCAD can be highly valuable to coordinate with your local team and help ensure your treatment plan reflects current evidence [1][2]. Expertise in SCAD does not eliminate clinical uncertainty, but it provides a framework based on the specific behavior of arterial dissections.

Screening Beyond the Heart

One of the most important steps following a SCAD diagnosis is evaluating the health of the rest of your vascular system. Expert consensus often recommends that patients undergo a comprehensive assessment of the major vessels from the head through the pelvis [3][4].

The Role of Fibromuscular Dysplasia (FMD)

The primary reason for this comprehensive scan is to check for Fibromuscular Dysplasia (FMD), a nonatherosclerotic condition where the structures of your artery walls grow abnormally [5][6]. FMD is highly prevalent in SCAD cohorts and can affect arteries far from the heart [7].

This screening is typically done using one of two types of high-resolution imaging, chosen based on your kidney function, contrast safety, and local expertise:

  • CTA (Computed Tomography Angiography): Uses X-rays and a contrast dye to create detailed images of your blood vessels [8].
  • MRA (Magnetic Resonance Angiography): Uses magnetic fields and radio waves, avoiding ionizing radiation [9][10].

The scan will examine the arteries in your brain, neck, abdomen, and pelvis to check for aneurysms, other dissections, or narrowing [11][6]. This scan does not guarantee that every vascular problem is excluded, but finding an abnormality (like FMD) does not automatically mean you need surgery; many vascular findings simply require periodic monitoring [9][12].

Specialized Care for Pregnancy-Associated SCAD (P-SCAD)

If your SCAD occurred during pregnancy or shortly after giving birth (the postpartum period), your care requires a specialized approach [13][14]. P-SCAD is often more severe than other forms of SCAD, and the postpartum period involves significant hormonal shifts [15].

An ideal multidisciplinary team for P-SCAD includes:

  • Cardiologists with SCAD expertise to manage heart healing.
  • Maternal-Fetal Medicine (MFM) specialists who manage high-risk pregnancies.
  • Obstetric Anesthesiologists to plan for safe deliveries.
  • Vascular Medicine specialists to manage FMD or other arterial issues.

If you are considering a future pregnancy, this team will work together to conduct an individualized risk assessment.

Genetic Testing Considerations

Routine genetic testing is not universally recommended for every SCAD survivor. However, referral for genetic counseling and potential testing may be considered if you have specific syndromic features, a strong family history of dissections or aneurysms, marked arterial tortuosity, or multiple spontaneous dissections [16][17]. About 5–10% of SCAD cases may be linked to rare genetic connective-tissue or arteriopathy disorders; a negative test does not entirely explain or exclude SCAD, but testing can guide management when appropriate.

Your SCAD ‘Toolkit’: Preparing for a Specialist

When you consult with a specialist, bringing your own “physical artifacts” is essential. Do not assume your medical records will be transferred automatically between hospital systems.

Gather the following items and keep them in a dedicated folder:

  1. The ‘Cath Lab CD’: This is the most critical item. Request the actual video files (in DICOM format) of your coronary angiogram so the specialist can review the moving images of your artery [7].
  2. Official Reports: Request the written “procedure report” from your cardiac catheterization, as well as the reports from your head-to-pelvis CTA or MRA [18].
  3. Lab Results and ECG: Ensure you have your peak troponin levels and any recent ECG tracings [19].
  4. Imaging Reports: Bring the results of your Echocardiogram or Cardiac MRI, which show your ejection fraction [20][21].
  5. Discharge Summary: The summary from your hospital stay provides a timeline and your prescribed medications [22].

Common questions in this guide

Why is vascular imaging recommended after SCAD?
A head-to-pelvis scan checks arteries in the brain, neck, abdomen, and pelvis for fibromuscular dysplasia, aneurysms, other dissections, or narrowing. Your clinician may choose CTA, which uses X-rays and contrast, or MRA, which uses magnetic fields; kidney function, contrast safety, and local expertise help guide the choice.
What is fibromuscular dysplasia, and why is it checked for after SCAD?
Fibromuscular dysplasia is a non-atherosclerotic condition in which artery walls develop abnormally. It is common in SCAD patient groups and can affect arteries far from the heart, so finding it may change how your care team monitors your blood vessels. FMD does not automatically mean surgery is needed.
Does everyone who has SCAD need genetic testing?
No. Routine genetic testing is not recommended for every SCAD survivor, but genetic counseling and possible testing may be considered if you have features suggesting a connective-tissue or arteriopathy disorder, a strong family history of dissections or aneurysms, markedly winding arteries, or multiple spontaneous dissections. A negative result does not fully explain or rule out SCAD.
Who should help manage pregnancy-related SCAD or a future pregnancy?
Care is best coordinated by a cardiologist with SCAD experience, a maternal-fetal medicine specialist for high-risk pregnancy care, an obstetric anesthesiologist, and a vascular medicine specialist. Together, they can assess your individual risks and plan care if you are considering pregnancy.
What should I bring to a SCAD specialist appointment?
Bring the actual coronary angiogram video files in DICOM format, the catheterization procedure report, head-to-pelvis CTA or MRA reports, peak troponin and ECG results, echocardiogram or cardiac MRI results with ejection fraction, and your hospital discharge summary. Keeping these records in one folder can help the specialist review your diagnosis, heart function, imaging, and medication history.
If my vascular scan finds FMD or another abnormality, will I need surgery?
Not necessarily. Some findings are managed with periodic monitoring rather than surgery, and the follow-up plan depends on which artery is affected and what the imaging shows. Ask your vascular or cardiology team how often you need repeat imaging and whether activities should be modified.

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References

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This page explains SCAD care teams and vascular screening for informational purposes only and does not constitute medical advice. Discuss imaging, genetic testing, activity, and pregnancy plans with your healthcare team.

Guide contents Idiopathic spontaneous coronary artery dissection
Research & Literature
04 Treatment Approaches 06 The Road Ahead