Frequently Asked Questions
Mount Sinai Heart physicians include some of the world’s preeminent authorities on fibromuscular dysplasia, cervical artery dissection (CvAD) and spontaneous coronary artery dissection (SCAD), or arterial tearing. These are some common questions that we hear from patients.
Q. What is the overall outlook for patients with FMD, CvAD, or SCAD?
Many patients live long lives with FMD, CvAD, or SCAD; however, as with many diseases, the prognosis depends on catching the disease early.
Q. Is there a cure for fibromuscular dysplasia?
While there isn’t a cure for FMD, there are a variety of treatments that can manage the disease.
Q. Is fibromuscular dysplasia a progressive disease?
To the best of our knowledge, the disease does not appear to progress. However, while a “string of beads” does not progress, other events such as a new dissection may occur. We can recommend certain treatments and lifestyle changes to make these events less likely.
Q. Why did it take so long for me to be diagnosed with FMD?
Many of the symptoms of FMD (such as high blood pressure, migraine headache, and dizziness) are nonspecific, meaning they can also occur in a large number of other conditions. Some patients have no symptoms at all, thus delaying diagnosis. And because some health care providers know very little about FMD, they may miss the diagnosis or take a long time to make it.
Q. How does SCAD cause a heart attack?
A heart attack occurs when the heart muscle does not receive enough blood supply. When a tear (SCAD) forms in an artery in the heart, blood flow can be reduced or blocked, which can then cause a heart attack.
Q. How does FMD cause a stroke?
In patients with FMD, stroke or mini-strokes (called transient ischemic attacks) occur as a result of carotid or vertebral artery dissection leading to decreased blood flow to the brain. Rarely, patients may also experience stroke due to a ruptured carotid artery; or a vertebral or cerebral artery aneurysm.
Q. Are FMD, SCAD, and CvAD genetic diseases?
Genetic factors may play an important role in FMD, SCAD, and CvAD, and our team has made several discoveries about the genetics of these diseases. However, it is also likely that hormonal and environmental factors contribute to the disease. Sex plays a major role as well, with the majority of patients being women. At Mount Sinai, we are performing genomic research that will increase our understanding about the causes of these diseases.
Q. Will this affect my children? Should they be screened?
We believe that genetic factors contribute to FMD. The adult variety of FMD occurs at some point after puberty. However, the average age of diagnosis of multifocal FMD is 52 years and focal FMD 30 years. There is a childhood form of FMD, which is quite uncommon and usually cared for by pediatric specialists. High blood pressure in young people is an early warning signal and should be thoroughly checked by a doctor. That said, if there is a history of FMD in the family, mentioning it to your doctor is a good idea.
Q. Is there a blood test for fibromuscular dysplasia?
Currently, there is no blood test or genetic test that can determine whether you have FMD. Noninvasive imaging such as a CT angiogram or MR angiogram can help diagnose typical multifocal or focal FMD, as well as arterial tearing or aneurysms that are caused by FMD. Our team is working to develop the first blood test for FMD, and we have already published in a major scientific journal that this is likely to be possible.
Q. Will changes in my diet and other lifestyle changes help treat these conditions?
Most patients benefit from taking an aspirin a day. There is no specific dietary advice, but maintaining a healthy weight and having a balanced diet is important. For patients with aneurysms or dissections, your doctor will have specific recommendations for your condition.
Q. What type of exercise can I do?
The type and amount of exercise is dependent on each patient’s condition. Regular aerobic exercise is usually recommended. Our physicians can provide individual guidance so patients can engage in activities safely. Speak to your doctor about your specific goals and limits.
Q. What is the likelihood of recurrence in patients with SCAD?
While many patients with prior SCAD have occasional chest pain, having a true recurrent SCAD event is less common, affecting only 10 to 20 percent of patients.
Q. Why do I still get chest pains after SCAD?
We believe that people who have SCAD may have changes in the way their vessels are able to dilate and contract, which may cause occasional chest pains. The ability of the vessels to dilate and contract is normal and is important for things like controlling blood flow. We believe that these changes in SCAD patients are minor, but they may still cause chest pain.
Q. What is the likelihood of recurrence in in patients with carotid or vertebral dissection?
The highest risk for a recurrent carotid or vertebral artery dissection is within the first month of the event (about 2 percent). Thereafter, data shows that the rate of recurrence is stable at 1 percent each year. Our center evaluated imaging and chart data for our patients with FMD and confirmed that new dissection rates after FMD diagnosis are the same (1 percent per year) and more often occur in FMD patients who have already experienced a dissection.
Like SCAD, patients with cervical artery dissection often experience lingering headache or neck pain, symptoms reminiscent of the original dissection event. This is very common and may also be due to the ability of the injured arteries to contract and relax. Additionally, patients who experience a dissection event are often very in tune with any changes in their bodies and understandably hyperaware. If you are concerned about any symptoms you are experiencing after a dissection it is best to discuss them with your doctor.
Q. What are my limitations after a carotid or vertebral artery dissection?
Each person’s physical limitations will be different, depending on their overall fitness and age. Patients should avoid chiropractic neck manipulation, shoulder or head stands in yoga, and traction on the neck in any form. Early on after a dissection, do not do any weightlifting. As time passes, light weightlifting (avoiding any straining) may be permitted. Cardio exercise may be reintroduced slowly during recovery; your physician will have specific recommendations for you.
Q. When can I have sex after SCAD or after carotid or vertebral dissection?
You should check with your doctor, but generally we consider it safe to resume sex several weeks after SCAD or a vascular dissection. A large part of this decision depends on each individual’s recovery and course of treatment.