Risk of SCAD in Young Mothers
A young woman, barely a week after giving birth, suddenly feels a tight, squeezing pain in her chest. Her family reassures her — “It’s just stress or weakness after delivery.” She tries to rest, unaware that what’s happening could be a silent and deadly heart emergency called Spontaneous Coronary Artery Dissection (SCAD).
What exactly is SCAD?
SCAD occurs when there is a tear or bleeding inside the wall of a heart artery, leading to blockage of blood flow to the heart muscle. Unlike usual heart attacks, which are caused by cholesterol deposits, SCAD happens without any plaque buildup. The sudden tear reduces blood supply, causing chest pain, heart failure, or even cardiac arrest in severe cases.
It often strikes women with no prior heart disease — during pregnancy or in the weeks following childbirth — making it both unpredictable and easily overlooked.
Why does it happen after pregnancy?
During pregnancy, a woman’s heart works nearly 50% harder to meet the body’s increased demands. Hormones such as estrogen and progesterone — essential for maintaining pregnancy — make arteries more elastic and delicate.
After childbirth, the heart faces abrupt physiological changes:
Blood volume and hormone levels drop sharply,
Emotional and physical stress peaks, and
Labour-related strain increases vascular stress.
In some women, these shifts can cause microscopic tears or bruises in the coronary arteries, triggering SCAD. Emotional distress, anxiety, or excessive exertion during the postpartum period can worsen the risk.
Recognizing the warning signs:
Sudden chest pain or pressure
Pain radiating to the arm, neck, or back
Shortness of breath, sweating, or dizziness
Unexplained fatigue or restlessness after delivery
These symptoms may be mistaken for acidity, anxiety, or postpartum weakness — a dangerous delay. Every postpartum chest pain must be taken seriously. An ECG and cardiac enzyme test can detect injury early and save lives.
How is it treated?
Most SCAD cases are treated medically with:
Beta-blockers to reduce heart strain
Antiplatelet agents or mild blood thinners
Lifestyle and stress management
Procedures like stenting or bypass are reserved for severe cases. With early diagnosis and proper management, recovery is usually complete within weeks to months.
SCAD in Asia — a hidden challenge
Studies from Asia, including India, reveal that 1–4% of all heart attacks are due to SCAD — a figure likely underestimated due to misdiagnosis. Among women under 50, particularly postpartum mothers, the proportion is even higher.
Many cases remain unrecognized because of:
Limited awareness among healthcare workers,
Under-reporting in rural areas,
Lack of advanced cardiac imaging facilities like coronary CT angiography.
To address this, India needs maternal cardiac surveillance — integrating postpartum cardiovascular screening into existing maternal health programs like Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) and the LaQshya initiative.
A community medicine perspective
From a public health lens, SCAD is a reminder that maternal care must go beyond delivery. Community-based interventions can make a life-saving difference:
- Postpartum cardiac screening:
Include blood pressure monitoring, pulse rate, and enquiry about chest discomfort during postnatal home visits by ASHAs or ANMs.
Develop simple checklists for identifying red flags in recently delivered women.
- Training health workers:
Train primary health centre (PHC) staff and community health workers to recognize heart attack symptoms in young women.Integrate modules on maternal cardiac emergencies in skill labs and LaQshya training.
- Public awareness:
Use village health and nutrition days (VHNDs) and social media to educate families that chest pain is not normal after delivery.Promote messages that “Maternal health includes heart health.”
- Health system strengthening:
Establish regional registries to record and track SCAD cases.
Encourage referral linkages between obstetric units and cardiology departments for postpartum emergencies.
- Lifestyle and stress management:
Promote rest, mental well-being, and family support during the postpartum period.Educate families to avoid pressuring new mothers into early physical strain or emotional stress.
SCAD reminds us that motherhood should not cost a woman her heart. Every episode of unexplained chest pain in a young mother deserves medical attention, not reassurance.
By strengthening community surveillance, empowering frontline workers, and spreading awareness, we can ensure that no mother’s heart silently breaks after giving birth.
Dr Zaid Zahoor is MD (Preventive Medicine Physician)
