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Heart attacks are more commonly associated with sudden, crushing chest pain with some dramatic aftermath. It is also often thought of as something older or visibly unhealthy people face. But what if one strikes with hardly any warning, and the victim does not fall under the usually vulnerable age bracket?

Recent research shows that silent heart attacks (also called silent myocardial infarctions, SMIs) are more common than many realise, especially among women who seem healthy and relatively young. These “stealth” events may show up later when damage has already been done, increasing the risk of complications and even death.


One surprising culprit is Spontaneous Coronary Artery Dissection ( SCAD ), a condition where an artery in the heart tears on its own, often without the usual warning signs. Because SCAD can be silent or show vague symptoms, it is frequently missed or misdiagnosed, putting many women in danger.

In this article, let’s attempt to understand what SCAD is, who is most at risk, and how to spot and respond to it early, which could save lives.


SCAD: The silent threat lurking behind healthy hearts

Spontaneous Coronary Artery Dissection, or SCAD, is an uncommon but serious condition in which a tear or separation develops in the wall of a coronary artery (which supplies blood to the heart). This tear can lead to bleeding into the artery wall, swelling, or a “false channel” that restricts normal blood flow. In severe cases, this can result in a heart attack.

What makes SCAD especially concerning? The fact that it often occurs in women who are otherwise considered healthy, with no high cholesterol, no heavy smoking history, and no classic risk factors.



Who’s at risk of having SCAD?

Although SCAD is rare compared to traditional heart attacks caused by blockages from cholesterol or clots, it is now recognized as a major cause of heart attacks in younger women. It tends to affect women under 50, often without the usual risk factors. Pregnancy or the period shortly after giving birth appears to be one of the more common triggers. Hormonal changes, certain connective tissue disorders, high stress, inflammatory conditions, and even genetics may also play a role.

Apart from these physical signs, mental health also emerges as a significant factor. Depression and anxiety in younger women are linked to a higher likelihood of developing traditional cardiovascular risk factors (like high blood pressure, high cholesterol, and diabetes) over time.

Some lifestyle and socioeconomic factors, too, make a difference.

A Yale-led study found that for women aged 55 and younger, risk factors such as hypertension (high blood pressure), diabetes, being a smoker, having a family history of heart attack, low income, and high cholesterol had stronger links to heart attack risk than in men of the same age.


Why SCAD is hard to detect

SCAD is tricky to diagnose because its symptoms are often subtle or atypical. Women suffering from SCAD may experience:

Chest pain or tightness, but sometimes mild or only during exertion

Shortness of breath

Fatigue, sometimes days before anything more serious happens

Jaw, back, or arm pain

Sometimes no symptoms at all (“silent” events)

Because many women and even doctors may not expect someone young and “healthy” to have a serious heart event, symptoms are sometimes dismissed or attributed to less serious causes (stress, indigestion, muscle pain). Standard tests may miss SCAD if not specifically looked for. For example, angiograms may not detect tiny tears or dissections unless special imaging techniques or heightened awareness are applied.



Prevention, awareness, and action

Because SCAD and related silent heart attack risks are so often missed, awareness is vital – for both women themselves and healthcare providers. Here are some practical tips that can help:

Know your personal risk: Even if you are young and seem healthy, factors like mental health, family history, pregnancy history, or unusual symptoms matter. Don’t assume you are immune.

Pay attention to symptoms, however mild: Chest discomfort, unusual fatigue, breathlessness, jaw/back pain. If these feel ‘off’, get medical attention.

Use proper diagnostic tools: If initial tests are normal but symptoms persist, advanced imaging, careful ECG interpretations, angiography with techniques to detect tears, etc., may be needed.

Manage traditional risk factors: Keep blood pressure, cholesterol, and blood sugar in check. Avoid smoking, maintain a healthy weight, get regular exercise, and eat a balanced diet. Stress management is important too.

Mental health care counts: Dealing with anxiety and depression isn’t just good for the mind – it affects the heart. Early treatment and preventive care here may reduce cardiovascular risk.

Post-event follow-up: Women who have had an SCAD event or heart attack need careful monitoring. Studies show that younger women have higher rates of rehospitalisation in the year after a heart attack than men, especially for non-cardiac issues like depression, and socioeconomic factors also play a role.