At 42, she had a heart attack at work though she was fit and a non-smoker: What hidden condition caused it?

Unlike a conventional heart attack, which is usually caused by a cholesterol plaque rupturing and forming a clot, SCAD occurs when a tear or separation develops within the wall of a coronary artery. (Photo/AI-generated)

She was 42 and walked into our hospital with chest discomfort and collapsed almost instantaneously. She seemed fit enough, was one of the most productive professionals at work, had betrayed no signs of illness, was cheerful during the day and felt uneasy and dizzy on the stairwell on her way out of the office. She had no family history, no known conditions or risk factors, and was a non-smoker. Most importantly, she was in the reproductive age, when every woman gets benefits of estrogen which protects the heart. What went wrong then?

Such cases are no longer rare and over the course of the last decade, I am seeing more and more women in their 30s and 40s presenting with heart attacks and other acute coronary syndromes. The American Heart Association’s 2026 scientific statement on acute coronary syndromes in premenopausal women highlights this as an under-recognised problem and points to both conventional and non-atherosclerotic causes of heart attacks in younger women.

A different cause of heart attack in younger women

One condition that is triggering heart attacks in younger women is spontaneous coronary artery dissection (SCAD). Unlike a conventional heart attack, which is usually caused by a cholesterol plaque rupturing and forming a clot, SCAD occurs when a tear or separation develops within the wall of a coronary artery. Blood can enter the artery wall, separating its layers and narrowing or blocking the channel through which blood reaches the heart muscle. This can cause a heart attack and, in severe cases, trigger dangerous heart rhythms that can lead to cardiac arrest or sudden cardiac death.

SCAD disproportionately affects women and can occur in those who have none of the traditional cardiovascular risk factors. SCAD also changes the way a heart attack may be treated. Unlike a conventional blocked coronary artery, where angioplasty and a stent may be used to restore blood flow, putting a stent into a dissected artery can potentially extend the cut or cause further injury. If the patient is stable and blood flow is adequate, doctors may opt for conservative treatment and allow the artery to heal naturally.

However, intervention may be necessary when the blood flow is reduced. Importantly, SCAD is serious but does not necessarily mean a poor long-term prognosis: most patients who survive the initial event have a favourable outlook, although recurrence can occur and long-term follow-up is important.

What are triggers for SCAD?

Pregnancy and the period following childbirth are recognised settings in which SCAD can occur, while physical exertion and severe emotional stress have also been associated with some cases. Mind you, more and more women are balancing demanding professional careers with family responsibilities and other sources of physical and emotional stress.

The precise mechanism is still being studied, with researchers examining hormonal influences, abnormalities of the blood vessels, genetic factors and connective-tissue disorders.

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Estrogen offers protection, but it is not immunity

Pre-menopausal women generally have a lower cardiovascular risk than men of the same age, and estrogen is thought to contribute to that relative protection. But women can still develop important cardiovascular risk factors during their reproductive years. Smoking, high blood pressure, diabetes, obesity, abnormal cholesterol and physical inactivity can all increase the risk of coronary disease.

The transition towards menopause can further change the cardiovascular risk profile, with metabolic risk factors often becoming more prominent during midlife. Now the risk profile of men and women is hardly different.

Why younger women may delay seeking help

Another challenge is that a woman in her 30s or 40s may simply not believe she is having a heart attack. Chest discomfort can be mistaken for acidity, indigestion, anxiety or exhaustion. Women may also experience breathlessness, nausea, sweating, unusual fatigue or discomfort in the arm, back, shoulder, neck or jaw. But any delay reporting these symptoms matters because acute coronary syndromes require urgent assessment and treatment.

We have to understand now that when it comes to women, there is no longer a single pathway to a heart attack. Age and reproductive status should not be used to dismiss cardiac symptoms.

(The author is Group Chairman, Cardiac Sciences, Max Healthcare)