SCAD: The Leading Cause of Heart Attacks in Pregnancy & Postpartum

Women are having heart attacks as young as in their thirties, according to research. And the leading cause of younger women having heart attacks, especially related to pregnancy and postpartum, is a condition called spontaneous coronary artery dissection (SCAD). 

Taelur Littlejohn was just 27 when she gave birth to her third son and experienced a heart attack. All three of her pregnancies were relatively normal, but toward the end of the third pregnancy, she noticed significant heartburn, fatigue, and swelling in her legs and feet. Right before she delivered, she had some flu-like symptoms and was admitted to the hospital, but tested negative for COVID-19 or the flu (it’s unknown if these symptoms were a precursor to SCAD). Her labor this third time around was significantly more strenuous than the other two deliveries. “I didn’t think that I could finish it,” Littlejohn says. Her swelling was even worse after birth, which she didn’t think felt right, but healthcare workers assured her that it was normal after having a baby. “Now thinking back on how many women are misdiagnosed or unheard, it was one of those situations. I shouldn’t have been released to go home with a newborn and my blood pressure as elevated as it was,” Littlejohn adds.  

The following day, Taelur knew something wasn’t okay — she woke up from a nap with a slight headache, and when she went to pick up her son, she felt a striking pain in her chest. “It felt like an elephant was sitting on my chest—I couldn’t breathe,” says Littlejohn. At that moment, she instructed her oldest son, then nine, to call 911. When paramedics arrived and she expressed that she thought it was a heart attack, the EMTs assured her that she was too young to be having a heart attack at 27 and that it was likely anxiety given that she just had a baby. She was positive she didn’t just have anxiety. 

It turned out that Littlejohn was accurate: Her troponin (a protein in heart muscle that is a marker of heart damage) was sky high. After a week in the hospital and a transfer to a cardiovascular health-specific hospital, Littlejohn ended up having a triple bypass open heart surgery, going into a medically induced coma, and spending four months recovering in the hospital and then in cardiac rehab. It’s been a long road, starting at just 10 percent heart function when she was in recovery. 

If she hadn't advocated for herself and insisted on having her symptoms addressed right away, Littlejohn may not be here to raise her three sons. Through the American Heart Association’s Go Red for Women movement, she’s raising awareness about SCAD, which can happen to people with healthy pregnancies, even if they don’t have a prior history of heart conditions.

What is a SCAD heart attack?

Most commonly, postpartum heart attacks are due to SCAD, a spontaneous coronary artery dissection: a tear in the arteries that supply oxygen to the heart, explains Lily Dastmalchi, DO, MA, a preventative cardiology and women’s cardiovascular health specialist at Inova Schar Cancer Institute in Fairfax, VA. It’s possible for blood trying to pass through the arteries to get blocked or trapped, causing swelling and potentially causing a heart attack.    

How do you know if you’re at risk for SCAD?

Pregnancy and birth are some of the main risk factors for a SCAD-induced heart attack.  “Postpartum heart attacks are still pretty rare [there are about two cases in every 100,000 people], however more frequent than women of similar age who are not pregnant,” says Dr. Dastmalchi. “They most commonly occur during the last week after delivery and the risk remains up to 6 weeks postpartum.”  The risk of pregnancy-related heart attacks is four times higher for people who are pregnant or have given birth than people of the same age who aren’t pregnant or postpartum, according to 2020 research published by the American Heart Association. Cases of stress-induced postpartum heart attacks are rising in people as young as 30, and Black women are disproportionately affected.

Stress on the body during pregnancy, especially in the form of high blood pressure can increase your risk, but more research needs to be done, says Dr. Dastmalchi. Monitoring for and maintaining a healthy blood pressure is key for a healthy pregnancy, she says. 

Also, certain health conditions, such as fibromuscular dysplasia (FMD), a disease of the medium to large-sized arteries that’s more common in women than men can contribute to SCAD risk, explains Dr. Dastmalchi. However, Littlejohn tested negative for FMD or any other similar condition that might exacerbate her risk, for example.  

SCAD symptoms to look for

“The signs of a peripartum and postpartum heart attack are similar to a traditional heart attack,” says Dr. Dastmalchi. You should look out for any chest pressure or tightness, shortness of breath, dizziness, excessive sweating, or nausea. 

Symptoms that Littlejohn experienced were not originally flagged because they all can mimic pregnancy symptoms, like heartburn, swelling, and even shortness of breath. “SCAD is not talked about enough — even my OB was not aware of it,” Littlejohn says. She’s pushing for more conversations about SCAD-induced heart attacks, and with more awareness, more thorough cardiovascular screening during and after pregnancy and birth.

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Mara Santilli is a journalist reporting on health and wellness and how social and political systems influence the well-being of certain groups, including but not limited to Black and brown communities, women, and the LGBTQ+ community. Her editorial work has appeared in publications such as Shape, Marie Claire, Cosmopolitan, Women’s Health, InStyle, Glamour, and more. Outside of reading and writing, she enjoys traveling (especially to Italy), singing, dancing, musical theatre, and playing guitar and piano.