Tara’s Story: Finding a New Purpose after SCAD

Tara Benoit, 47, was an active, healthy mother of two boys living in southern New Hampshire when sudden chest pains changed her life forever.

A successful business owner and CEO of her own recruiting firm, she also was a dedicated athlete and participant in fitness competitions. She was the last person friends and family ever expected to have a heart problem. But in May 2023, she started having episodes of severe chest pain that kept getting worse. Tara was eventually diagnosed with a spontaneous coronary artery dissection, or SCAD.

“It blows my mind that this happened when it did, because I was getting ready for my next fitness competition,” Tara says. She was in the best physical condition of her life.

SCAD is a rare condition where the coronary artery, a major blood vessel which supplies oxygenated blood to the heart, tears without warning. This causes bleeding within the wall of the vessel and disrupts blood flow to the heart muscle. It can lead to heart attacks and cardiac arrest. It's such a rare condition that Tara had a hard time getting an accurate diagnosis and the right treatment.

Fortunately, she was referred to Sarah Tsiaras, MD, a Mass General Brigham cardiologist who cares for patients at Massachusetts General Hospital. Dr. Tsiaras is part of the SCAD Program within the Corrigan Women’s Heart Health Program, which is one of the few centers in the country that specializes in caring for patients with SCAD.

“I was so happy that I found a place near me that has some of the best doctors in the whole world. At that moment, my recovery started getting better. I felt like I had more faith that I was with the right people now,” says Tara.

Unexplained chest pains lead to devastating diagnosis

Tara’s chest pains started shortly after her family returned from vacation in May 2023. When she also started feeling a squeezing sensation of pressure in her heart, and tingling down her left arm, she went to the ER. Initial bloodwork and tests didn’t find anything wrong.

“One doctor suggested it might be anxiety. I said, ‘No disrespect, but it’s not anxiety.’ It's disturbing to me because I've met a lot of women in support groups, all different ages, with similar stories. We were written off as having anxiety, sent home because of the lack of knowledge,” Tara says.

The symptoms of SCAD are similar to a traditional heart attack and can often lead to a delay in diagnosis for patients. Symptoms can include:

• Chest pain

• Pain in the jaw, shoulder, or arm

• Shortness of breath

• Dizziness

• Nausea

• Sweating

Two days after returning home from the hospital, Tara experienced even more severe chest pains in her heart, along with shortness of breath, pain in her arm, jaw, and back, sweating, and fainting. An ambulance took her to another hospital.

Despite a normal EKG (a test which records the heart’s electrical signals), her bloodwork showed elevated troponin levels. Troponin is a protein found in heart muscle cells. Its presence in Tara’s blood indicated that she had damaged heart muscles. Doctors performed a cardiac catheterization. They threaded a thin, flexible tube through Tara’s blood vessels to examine the heart arteries in more detail.

It was during this procedure that Tara received her life-changing diagnosis of SCAD, which had led her to have a heart attack. “I was very thankful to be alive, but also devastated with my diagnosis and this new condition,” she says.

Tara found the SCAD Program after she returned home and began researching options to further her recovery. After her frustrating experiences trying to get a diagnosis and treatment, Tara appreciated the expertise at Mass General and felt comfortable with Dr. Tsiaras and the team.

“Everything was so seamless and so organized, and I hadn't had that before. It was all so reassuring. She knew everything about me. They had talked about my case with other doctors before I even got there, and I was blown away. I just was so impressed with the level of care,” she says.

SCAD risk factors

At Mass General, Tara was able to learn more about her serious new condition.

“Ninety percent of SCADs occur in women who have no cardiac history and who often don’t have the traditional risk factors for coronary artery disease, like high blood pressure (hypertension), high cholesterol, diabetes, smoking, or family history. The most common age is around 45 to 55, the perimenopausal years, but it can sometimes occur during the time of pregnancy as well,” says Dr. Tsiaras.   

The exact causes of SCAD, and why it mostly affects otherwise-healthy women, still aren’t fully understood. Potential causes can include:

• An underlying abnormality of the artery or blood vessel, as seen in some conditions like fibromuscular dysplasia. This is disorder where artery walls have abnormal development or growth of cells.

• A recent stressful emotional or physical event

• Hormonal changes seen in pregnancy or menopause

• Certain genetic conditions or mutations like Marfan syndrome, Ehlers-Danlos syndrome, or Loeys-Dietz syndrome

“Sometimes it can be a combination of an underlying vascular abnormality compounded by an emotional stressor. I’ve had patients struggling with their marriage, upset about an interaction with a client, or just under a lot of stress balancing career and family responsibilities,” Dr. Tsiaras explains.

At Mass General, doctors screen patients with SCAD for fibromuscular dysplasia. They also offer genetic testing to some patients. “More recently, we’re starting to think there may be a polygenic component, or multiple genes interacting together, leading to an increased risk for patients,” says Dr. Tsiaras.

Personalized treatment for SCAD

In addition to screening for potential risk factors and causes, the SCAD Program connects patients to a multidisciplinary team including cardiac geneticists, vascular medicine specialists, interventional cardiologists, cardiac radiologists, and a psychologist who specializes in working with heart patients. They work to develop individualized treatment and recovery plans for each patient.

Treatment for SCAD is a slow process, with careful monitoring of the patient. Patients may take prescription medications that thin the blood and control blood pressure. In certain severe cases, doctors may recommend surgery, like the placement of a stent or a coronary bypass.

“Unlike a traditional heart attack where the blood vessel is blocked by plaque, we try to manage it conservatively if we can. In most cases, the vessels will heal over a period of weeks if they’re left alone,” explains Dr. Tsiaras.

Cardiac rehabilitation and mental health support

Health care providers also counsel patients on how to return to their regular lives.

“We recommend a cardiac rehabilitation program for most of our patients, where they can get back to being active in a supervised setting. It gives patients confidence, knowing they’re in a safer environment with people monitoring their movements and blood pressure,” Dr. Tsiaras says.

Patients should avoid lifting heavy weights which require them to hold their breath, and extreme or anaerobic exercise. Dr. Tsiaras notes that once the vessel heals, moderate aerobic exercise appears to be safe. But patients should still be cautious. Researchers are currently studying the best way to counsel patients about exercise after SCAD.

“Cardiac rehab is extremely beneficial. It helped me so much to be with other people going through similar things. After SCAD, you can feel like you don’t trust your body. I used the tools I learned there to help regain my confidence,” Tara says.

There’s also an emphasis on mental health treatment as part of SCAD recovery. Patients learn ways to manage stress, process the trauma of their experience, and can even participate in group therapy sessions with other cardiac patients. Tara saw a Mass General psychiatrist who helped her adjust to her new reality. “The doctor told me he’d never worked with someone like me before, who had to change their lifestyle so much,” she says.

Tara also connected with other SCAD patients she’s met at Mass General and through different support groups. “It’s such an important thing for anyone healing. It could be just one person, but having other people who support you and understand what you’re going through makes such a difference.”

Avoiding strenuous activities and prioritizing mental health can help prevent a recurrence of SCAD, which is rare but happens in about 10% of cases. “I try to flip that around and say, there’s a 90% chance this won’t happen again. And we know that treatment to control blood pressure, exercise restrictions, and stress management helps with that,” says Dr. Tsiaras.