Symptoms & questions
SCAD: the heart risk women in perimenopause should know
SCAD — spontaneous coronary artery dissection — is a sudden tear in a heart artery that causes a heart attack in women who often have none of the classic risk factors. It disproportionately affects women around perimenopause, and it is badly under-recognised. This page exists for one reason: the chest symptom that gets waved away as "just anxiety" can, occasionally, be your heart — and knowing that could save your life.
Last verified: 10 July 2026 · reviewed against cardiology and menopause sources · re-verified quarterly
Emergency — call 112 now
If you have chest pain or pressure, pain spreading to your arm, jaw, neck or back, breathlessness, sweating, nausea, or fainting — call 112 immediately. Do not drive yourself. Do not wait to "see if it passes". Do not assume it is anxiety. It is always safer to be assessed at Mater Dei A&E and sent home than to wait out a heart attack. Women's heart symptoms are dismissed too often — this is the moment not to.
What is SCAD?
SCAD stands for spontaneous coronary artery dissection. The wall of a coronary artery — one of the vessels feeding the heart muscle — develops a sudden tear, and blood pools in the wall, squeezing the channel shut and cutting off flow. The result is a heart attack. It is spontaneous: no crash, no cause you did anything to bring on.
The crucial difference from a "typical" heart attack is that SCAD is not caused by cholesterol plaque. That's why it blindsides people — and doctors — when it happens to a fit, slim, non-smoking woman in her 40s with normal cholesterol.
Why does it affect perimenopausal women?
SCAD overwhelmingly affects women, and it clusters at moments of hormonal change — around pregnancy and around perimenopause and menopause. The exact mechanism is still being researched, but shifting sex hormones are thought to influence the strength and stability of the artery wall. Emotional or physical stress can be a trigger.
It is under-recognised precisely because the women it hits look low-risk. When a 46-year-old with no risk factors describes chest tightness, breathlessness and a racing heart, the path of least resistance is to call it anxiety — a diagnosis perimenopausal women are handed constantly. Most of the time chest tightness in perimenopause is benign. SCAD is the reason "most of the time" is not "always."
How is SCAD different from a normal heart attack?
| Feature | SCAD | Typical (plaque) heart attack |
|---|---|---|
| Cause | A tear in the artery wall | Cholesterol plaque rupture |
| Who | Often younger–midlife women, few or no risk factors | More linked to age, smoking, cholesterol, diabetes |
| Triggers | Hormonal change, intense stress; sometimes none | Long-term plaque build-up |
| The trap | Frequently mistaken for anxiety or a panic attack | More often recognised as cardiac |
The symptoms in the moment can look the same — chest pain, arm or jaw pain, breathlessness, sweating, nausea, fainting. You cannot tell SCAD apart from any other heart attack yourself, and you are not meant to. The action is identical: treat it as an emergency.
How does menopause change heart risk more generally?
Beyond SCAD, cardiovascular risk rises for all women after menopause. Estrogen has a protective effect on blood vessels and cholesterol; as it falls, blood pressure, cholesterol and the risk of heart disease climb — heart disease becomes the leading cause of death in women after menopause. This is why the years after your final period are the right time to know your blood pressure, cholesterol and family history, and why the mentor decade is framed around long-term heart and bone health, not just symptom relief.
None of that means panic. It means the "anxiety" label that women's cardiac symptoms so often get is exactly the thing to push back on. If your gut says something is physically wrong, that instinct deserves a doctor, not reassurance — see palpitations and anxiety in perimenopause for how to tell the everyday from the alarming.
When should I worry — and what do I do?
For anything sudden and severe — the emergency list in the box above — the answer is 112, now. For symptoms that are milder but new, recurrent or that don't sit right — exertional breathlessness, chest tightness on effort that eases with rest, unexplained fainting — book a prompt medical review and ask specifically about your heart. Bring the word "heart" into the room yourself; don't rely on being asked.
First question first: what's your stage?
Your heart-health picture shifts stage by stage. The free quiz places you in one of the 7 stages in about 10 minutes — the starting point for the whole conversation.
Take the free quiz →The Malta Menopause Kit includes the named-clinic directory, the GP conversation script and a sequenced plan for your stage — see the kit.
Sources
- American Heart Association Scientific Statement: Spontaneous Coronary Artery Dissection (SCAD) — heart.org.
- British Heart Foundation: SCAD (spontaneous coronary artery dissection) — bhf.org.uk.
- NHS: Heart attack — symptoms and when to call emergency services — nhs.uk/conditions/heart-attack.
- Emergency number in Malta is 112; Accident & Emergency at Mater Dei Hospital — materdeihospital.gov.mt.
- NICE NG23: Menopause — identification and management (UK) — nice.org.uk/guidance/ng23.