Heart Beat

Written by Alejandra Armstrong Category: Valley News Issue: May 2015
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It turns out, Judy had a condition called Spontaneous Coronary Artery Dissection (SCAD), in which an inner layer of a coronary artery tears, potentially leading to a heart attack. Like many people with SCAD, Judy exhibited no symptoms prior to those which landed her in the hospital. The discovery led her husband, Robert Alico, to found the first nonprofit to fund SCAD research, based at Mayo Clinic, via his SCAD Research foundation. He’s made it his life’s mission to raise awareness of and find better treatments for SCAD. Thanks to that research, more information – including the announcement in March by Mayo Clinic researchers of a genetic presdisposition for SCAD – is coming to light.

A former teacher and consultant for an investment company, Alico’s mission started in the home office he’d shared with his wife, with a phone call to Dr. Sharonne Hayes at the Mayo Clinic in Minnesota, who was already researching the condition. “Dr. Hayes said I was the first guy in the world to ask to fund SCAD research,” Alico says. “I saw my wife’s empty chair and said, ‘I’ll do it.’”

By the summer of 2011, he’d founded the nonprofit SCAD Research foundation. It has since raised $135,000 for a research program, which takes place at the Mayo Clinic in both Minnesota and Scottsdale. “Bob’s funding has supported us collecting specimens and supporting participation in the research,” Hayes says. “One of the things that has been great about the funding is that it... allows us to put the money where we see fit.”

Hayes has been researching the poorly understood disease for five years. Most of the information about SCAD comes from autopsies, case reports and survivors. In almost all cases, the victim is healthy with no history of cardiovascular complications and no prior health issues. SCAD begins with a slight tear in an artery, allowing blood to penetrate the layers of the organ and cause a hematoma, or swelling, that often results in arterial blockage. As far as what causes the tear, there’s no real answer yet, but research supports correlations between SCAD and hormonal changes women experience during pregnancy, extreme stress and exertion.

In March, Hayes’ research team announced they’d identified a familial association with SCAD, via the registry they created to review cases. The five familial links they found included both first-degree relatives (mother-daughter, identical twin sisters, sisters) and second-degree relatives (aunt and niece, first cousins), implying both recessive and dominant modes of inheritance.

SCAD has gone from being called “rare” to “uncommon”; a result of raising awareness among medical professionals. “Doctors are more often correctly identifying and diagnosing it now instead of diagnosing another type of heart attack or missing it altogether,” Hayes says. Angiograms offer a look into arteries but they aren’t always successful in showing SCAD.

Hayes says there’s a need for acute management of SCAD. “The research is telling us that we shouldn’t treat these patients the same way we treat victims of other heart attacks,” Hayes says. The best treatment for SCAD depends on the level of severity. In some cases, surgery like triple bypass is needed. In many other cases, doctors allow for spontaneous healing. Doctors also prescribe antiplatelets (aspirin), cardiovascular rehabilitation and a healthy diet.

Mayo Clinic research suggests that SCAD is the leading cause of heart attack in women under 40. Researchers started a biobank and SCAD registry to determine if there are any answers in genetic makeup. This endeavor relies on funding. It takes about $1 million to gather 300 genetic samples and analyze them individually, Alico says. But there’s more direction now than five years ago.

Goodyear resident Christie Shears sends blood samples to the biobank. She survived a SCAD heart attack in 2013, three days after giving birth to her second child, at 28 years old. “I may not know in my lifetime,” Shears says, “but if they find the answer in time for my kids and their families – that’s what matters.”

SCAD Quick Facts
82% survival rate. - Much more promising than the originally believed 70 percent mortality rate.
80 % of cases occur in women.
50 to 60 % of SCAD victims also experienced fibromuscular dysplasia (FMD), a condition that causes narrowing of arteries and aneurysms.
42 is the average age of SCAD victims.
20 % of cases happen shortly after pregnancy.