Spontaneous coronary artery dissection in association with strenuous exercise and weightlifting is rather sparsely described in the medical literature. Diagnosis S pontaneous coronary artery dissection (SCAD), a rare cause of myocardial infarction (MI) and sudden cardiac death, can present with various acute coronary symptoms. It usually occurs in the peripartum period. In association with strenuous exercise and heavy lifting, SCAD is rather sparsely documented in the medical literature. We report the case of a patient in whom heavy lifting caused SCAD, and we review the literature on this topic. Case ReportIn January 2014, a 54-year-old woman had acute-onset retrosternal chest pain immediately after gardening and disposing of a heavy basket of cut grass. She had a normal body weight, no relevant medical history, and no known risk factors for coronary artery disease. She was 4 years postmenopausal. After an hour of worsening pain, she presented at the emergency department, having experienced cardiac arrest and resuscitation en route. After she was intubated, an electrocardiogram (ECG) showed ST-segment elevation in leads V 2 through V 5 , so she underwent thrombolysis. The patient's troponin T level was elevated at 0.4 ng/mL. The next day, her ECG results were consistent with anterior MI. Coronary angiograms revealed a spiral dissection of the left anterior descending coronary artery (LAD) (Fig. 1), which was successfully treated by means of angioplasty and the implantation of 3 drug-eluting stents. The rest of the coronary tree was smooth. The patient was discharged from the hospital after an uneventful 6-day stay, with instructions to take aspirin, prasugrel, a β-blocker, and a statin. Seven months later, results of an exercise ECG were normal, and the patient had returned to normal activity and full-time work. DiscussionCoronary artery dissection refers to the splitting of the arterial wall layers, the result of which is a false lumen. This dissection can occur spontaneously; after chest trauma, percutaneous coronary intervention, or cardiac surgery; or as part of aortic dissection. Accumulated blood in the false lumen can encroach on the true lumen, thereby impairing blood flow and causing myocardial ischemia, MI, or sudden cardiac death. [1][2][3][4][5] Since the first description of SCAD, 6 approximately 320 documented cases have been reported. This figure might be misleading, because many of the reports were Case Reports

Background: Outbreaks of acute hepatitis A (AHA) have recently been reported in Europe among men who have sex with men (MSM). The aim of this work was to evaluate, for the first time, trends in the reported cases of AHA in Cyprus over the last seven years. Methods: We retrospectively studied all people reported with AHA in Cyprus between January 2013 and December 2019. Demographic data, type of transmission, vaccination status for HAV, laboratory and clinical data were analyzed. Results: The asnalysis involved 33 AHA cases (age 32.7 ± 17.4 years, 78.8% males). An increase in AHA reports was observed between July 2017 and June 2018 when more than a third (n = 13) of the cases of the period 2013–2019 were reported. The reporting rate of AHA doubled from 0.52 cases per 100,000 population (before July 2017) to 1.12 cases per 100,000 population (July 2017–June 2018). The male/female (M/F) ratio increased from one in 2013 to eight in 2018. Conclusion: An increase in AHA reports occurred in Cyprus between July 2017 and June 2018. Many cases with AHA in that period were MSM. Enhanced surveillance and timely public health interventions, like vaccination and awareness promotion, are important for preventing future outbreaks.