60-90% of SCAD patients experience recurrent chest pain after SCAD (Post-SCAD Chest Pain Syndrome), according to studies referred to in the European Position Paper on SCAD. (You can request Beat SCAD’s summary of the European Position Paper using the Downloads form.)

Hospital readmission for chest pain after SCAD is also very common. Given the risk of recurrence (circa 10%), it is recommended that ECG and Troponin blood tests should always be done.

In some patients further along in their recovery the pain is cyclical, usually pre-menstrual. Anecdotally, cyclical symptoms may respond to low-dose contraception (eg the progesterone hormonal ‘Mirena Coil’). For those who get non-cyclical spasm-like pain, vasodilator treatments may reduce vasospasms.

While the cause of post-SCAD chest pain is not fully understood, SCAD specialists recognise it and have observed that, over time, for most patients, it does get much better.

SCAD specialist Dr David Adlam told us: “We don’t know why post-SCAD chest pain happens although there are some theories, such as a persistent tendency to have artery spasms or disruption of nerves in the heart that run along the side of vessels. Anything that damages nerves takes a long time to heal."

What Dr Adlam says about chest pain after SCAD (starts at 19 minutes)

Typically, for most patients, it will have faded into the background by 24 months (much sooner for many). However, a small number (much less than 10%) continue to experience chest pains longer than that.

If you’re having ongoing chest pain or other symptoms, jotting down symptoms (physical and mental) and feelings may help you to spot triggers for chest pain after SCAD. Common triggers are things like dehydration, tiredness, doing too much too soon, doing some new form of physical work for the first time after your SCAD – eg vacuuming, hanging out washing, carrying heavy shopping etc. A journal is helpful for medical appointments recapping key events and dates etc. Also for illustrating that eventually the bumps in the road get smaller and spaced further apart.

Watch Dr Adlam talk about this here (starts at 34 minutes) and here (starts at 42 minutes).

Please note: ongoing chest pain should not to be confused with pain in the first couple of weeks after the SCAD. Evidence suggest the majority of SCADs will heal over time. The preferred method of treating SCAD, unless intervention is clinically necessary, is conservative management (with medication only), and SCAD experts suggest patients are monitored in hospital for at least five days, because if conservative management doesn't work, recurrent SCADs tend to happen soon after the initial SCAD. Remember, only around 10% of patients have another SCAD, which means 90% don't, however it is wise to be cautious in the early days.

What is INOCA?

If you have ongoing post-SCAD chest pain beyond two years, please seek guidance from a SCAD specialist. You might also like to read more about INOCA in case this is relevant to you.

INOCA (Ischaemia with Non Obstructed Coronary Arteries) is a collective term for conditions such as: Coronary Microvascular Dysfunction (Microvascular Angina), Coronary Artery Spasm and Takotsubo.

Like SCAD, INOCA conditions are often misunderstood and are also frequently under-recognised, under-diagnosed and under-treated.

Frustratingly, this sometimes leads to people being told there is nothing wrong with them, when there is.

Patient-driven initiatives such as INOCA International hope to speed up research into microvascular angina, as well as help share information currently available regarding diagnosis and treatment of this complex and disabling condition. It is hoped that this important work will also be of help to the SCAD community.

Click on the sections below to find out more about Medications and SCAD, Checking for Healing, Cardiac Rehab and Exercise after SCAD.

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