Unexplained chest pain in women? Cardiologist explains why it could be SCAD and not a blocked artery

Heart attacks aren’t just something that happens to older men or women with high cholesterol. For many younger women in their 30s, 40s and early 50s, there’s a silent culprit that doctors are spotting more often: Spontaneous Coronary Artery Dissection, or SCAD.

Dr Mitesh Kumar F, Senior Consultant – Interventional Cardiology at Fortis Hospital, Bengaluru, tells Moneycontrol, “SCAD is often missed because it doesn’t follow the usual rules. Many young women with few risk factors end up in the emergency room with a heart attack, and it’s not caused by blocked arteries as most people think.”

Explaining SCAD, Dr Kumar says, it happens when a tear forms in the wall of a coronary artery, reducing blood flow to the heart. “Unlike the more familiar heart attacks caused by cholesterol build-up, SCAD is linked to fragile arteries, hormonal changes, connective tissue disorders, inflammation, or intense stress — emotional or physical.”

Also read | Symptoms of heart attack in women: Beware of chest pain, fatigue, cold sweat and more

Hormonal fluctuations during pre- and peri-menopause, he says, can make arteries weaker, and life’s pressures add another layer of risk. “Even women who eat well, exercise, and have no traditional heart problems can be vulnerable,” he warns.

Symptoms of Spontaneous Coronary Artery Dissection (SCAD)

According to Dr Kumar, the symptoms can be dramatic or very subtle, which makes SCAD tricky to catch. They include:

• Chest discomfort or pressure


• Jaw, back or arm pain


• Shortness of breath


• Dizziness or light-headedness


• Extreme fatigue

Dr Kumar warns, “A woman might brush off mild chest discomfort as stress or tiredness. But in SCAD, even these small signs can signal a life-threatening tear in a coronary artery.”

Reasons why SCAD is often missed

Dr Kumar explains reasons why SCAD is often missed:

• Non-classic symptoms: They can mirror signs like stress, indigestion, or general fatigue


• Standard test may appear normal: Routine ECGs or blood tests often, don’t pick it up


• Advanced imaging is required: Coronary angiography, sometimes with intravascular ultrasound (IVUS) or optical coherence tomography (OCT), is required for a clear diagnosis


• Most cases heal naturally: Unlike typical heart attack attacks, 90-95 percent of SCAD cases recover without stents, thus making correct diagnosis, essential


• Awareness is key: Women and doctors alike, need to consider SCAD, even when traditional risk  factors are  absent

Dr Kumar stresses, “Raising awareness among healthcare professionals and women is vital. Timely diagnosis can make the difference between a full recovery and serious complications.”