Young women who suffer "out of the blue" heart attacks are being failed by cardiac services which remain geared towards middle-aged men, a leading expert has said.
Lis Neubeck, a professor of cardiovascular health at Edinburgh Napier University, is spearheading a project to transform rehabilitation and screening for a rare form of heart attack known as ‘spontaneous coronary artery dissection’ (SCAD).
It is caused by tears inside the coronary artery which allow blood clots to form, blocking the heart.
SCADS strike without warning and the vast majority of cases - around 80-95 per cent - occur in women.
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They tend to develop suddenly in women aged 45 to 53 but are also known to strike during or soon after pregnancy, and in some cases can be fatal.
Roughly 2,500 women under 60 survive heart attacks in Scotland every year, and around a quarter will have been caused by SCADs.
Most patients who suffer a SCAD have none of the usual risk factors for a heart attack - such as high cholesterol, diabetes or smoking - which can lead to symptoms such as chest pain, nausea, and breathlessness being misdiagnosed.
Prof Neubeck, a cardiac nurse who heads the newly-established Centre for Cardiovascular Health Research at Napier, said: "Because we don't expect to see heart attacks in young women, what tends to happen is that they get told they're anxious or that this 'couldn't possibly' be a heart-related issue.
"I don't want to say they're dismissed, but their symptoms are downplayed until a later stage compared to men of the same age.
"That happens not just for SCAD, but for any cardiac event in women."
Prof Neubeck is about to begin recruiting survivors for project which aims to create a tailored recovery pathway for SCAD patients, which can then be scaled up UK-wide.
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It comes as around 500 delegates descend on Edinburgh today for a two-day conference by the Association of Cardiovascular Nursing and Allied Professions, which Prof Neubeck has been instrumental in bringing to the capital.
One of the obstacles for the NHS is that the majority of patients referred into cardiac rehabilitation services tend to be older men whose heart problems are more likely to be linked to lifestyle factors such as obesity or smoking.
By contrast, many women who suffer SCADs are healthy and active prior to their heart attacks.
"Cardiac rehab has traditionally attracted men in their 60s," said Prof Neubeck.
"But when we look at SCAD patients, they are predominantly women, usually younger women - under 50.
"They may have just had a baby - it often occurs at times of hormonal change - so they go along to these programmes that are aimed at older men and they may be the only young women there.
"What we're trying to understand is, what would be the best recovery support for these women? What kind of support and advice do they need?
"For example, how much physical activity can they do? Because often these women had been very fit before they had their cardiac event.
"We tend to be very conservative and say 'you really shouldn't do very much', yet we know from some studies that they can do exercise following a SCAD - we just don't know how much and what's safe to recommend.
"We're really keen to speak to people in Scotland who've had SCAD and understand their recovery."
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It remains a mystery why women are more likely than men to suffer SCADs, but health researchers are keen to find ways to identify those at risk much earlier.
Potential avenues could include targeted screening for high blood pressure and an irregular heartbeat - both known precursors to a SCAD - among higher risk women, but this requires a clearer understanding of what causes the phenomena in the first place.
Prof Neubeck said: "We still really don't know what causes SCADs, but there's lot of research going on - mainly in Leicester, but we are hoping to do more research on the causes of SCAD here in Scotland in the not too distant future.
"We don't know yet whether screening could identify women at risk earlier.
"There are some common genes that seem to be associated with it, but there's quite a lot of them so we're not there yet.
"There's also a connective tissue disorder called fibromuscular dysplasia (FMD) which is more common in people who have had SCAD.
"We know that people identified with FMD were at greater risk of having these dissections, so if we know they've got FMD then potentially we can help them.
"One of the key things would be to make sure they have well controlled blood pressure, because the blood pressure increases the stress on the inside of the coronary arteries."
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