Identified correctly

If a tear develops in a coronary vessel it can lead to a heart attack. Pregnant women in particular are affected. The cardiologist Christian Templin heads an international research project aiming to identify and treat the condition more effectively.

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Thirty-four-year-old Anna Bühler was pregnant with her second child when she felt a stabbing pain in her chest and belly while out for a walk. After rushing to the emergency department at University Hospital Zurich (USZ), she was diagnosed with a heart attack. But it was no classic heart attack. The trigger was a tear in the innermost layer of a coronary vessel, a so-called spontaneous coronary artery dissection (SCAD). This causes blood to accumulate and constricts or blocks the vessel, resulting in a heart attack.

“The fact that the condition is harder to diagnose than a classic heart attack means it’s not always detected,” explains Christian Templin, Senior Attending Physician at the USZ Department of Cardiology. It’s estimated that around 600 people in Switzerland are affected by this rare condition every year. Physical and mental stress are suspected to be risk factors. Given that pregnancy brings such physical and mental upheaval, perhaps this is why pregnant women are affected more frequently than average.

For the moment these are just hypotheses, because a number of questions are still unclear: How does a tear of this sort come about in the first place? In which patients does the tear heal on its own, and who needs a catheter intervention to reopen the blood vessel? Around one third of those affected can also expect to suffer another incident in the course of their lives; here, too, it’s unclear which risk factors come into play.

Research is needed to resolve these questions. Given that this is a rare condition, international collaboration is required to be able to investigate a sufficient number of cases. This has prompted Christian Templin to launch an international SCAD register at USZ. Around 60 cardiac centers in 16 countries have already expressed an interest in taking part by reporting cases of SCAD and providing tissue samples for a biobank.

This undertaking by Christian Templin and his team is being supported by a donation from the Iten-Kohaut-Stiftung to the USZ Foundation. An important aim of the project is to find biomarkers in the blood to be able to diagnose the condition more easily and distinguish it more clearly from a classic heart attack. The hope is that the register will also provide information necessary to develop the best possible treatment.

Anna Bühler can look forward to the rest of the pregnancy with peace of mind. Her blood vessel has recovered. She knows this because the USZ cardiac catheter lab always does a follow-up examination. Thanks to biomarkers, this will hopefully be even easier in the future.

*anonymized/symbolic image

60% financed

Iten-Kohaut-Stiftung