A 19-year-old healthy male collegiate athlete presented with typical anginal symptoms after running a 5K race. He had complained of similar symptoms off and on for the past month. On presentation, troponin was 0.12 ng/ml (reference value < 0.01 ng/ml), which peaked at 17.7 ng/ml and CK-MB was 28.71 IU/L (reference value < 25 IU/L). ECG showed diffuse biphasic T-waves. Coronary computed tomography angiogram (cCTA) demonstrated a 1.5 cm dissection in the left anterior descending artery and a 1.9 × 1.8  cm attenuation defect in the left ventricular apex consistent with thrombus. Subsequent coronary catheterization confirmed dissection of the left anterior descending artery. Spontaneous coronary artery dissection (SCAD) is a rare phenomenon. Diagnosis can be made through noninvasive measures but is usually done through left heart catheterization. In young patients who present with an NSTEMI, clinical suspicion for SCAD among other conditions should be raised. Additionally, recognizing that complications such as intracardiac thrombi can occur in SCAD is critical in ensuring appropriate therapy.

Background: Education is one of the determinants of health as described by the WHO, and it is one of the primary determinants of Socio-Economic Class (SEC), a higher level of education is associated with a higher level of SEC. Few researchers have addressed the link between the level of education and cardiovascular disease. However, there remains a need for a national study to determine the relationship between the level of education and cardiovascular disease. In this study, we investigated the effect of the level of education on the rate myocardial infarction (MI) and cardiovascular risk factors including diabetes mellitus, hypertension, hypercholesterolemia, and smoking status. Methods: The National Health Interview Surveys of 2016 (n=73,353) were utilized to measure the effect of level of education on MI and other risk factors. Subjects were assigned into four groups based on the level of education. The first group labeled as no education till the 12th grade, the second group identified as General Education Diploma (GED) or a high school diploma, the third group included subjects with some college, associate degree or bachelor, and the fourth group designated for subjects with master’s degrees, professional degrees, or doctorates. Logistic regression models were used to examine the association between level of education and cardiovascular risk factors. The final model examined the association between level of education and MI after adjusting for demographics and cardiovascular risk factors. Results: A higher level of education was associated with lower odds of having cardiovascular risk factors. The final logistic regression model revealed that subjects with GED and high school education (OR 0.80, 95% CI 0.65-0.97; p 0.027), subjects with some collage degree/ bachelor degree (OR 0.74, 95% CI 0.61-0.90; p <0.003), and subjects with master degrees or professional degrees (OR 0.58, 95% CI 0.43-0.78; p <0.001) have lower odds of having MI compared to the first group after adjusting for other risk factors including age, gender, diabetes mellitus, hypertension, hypercholesterolemia, and tobacco use. Conclusion: This study unveiled that a higher level of education is associated with a lower rate of myocardial infarction and cardiovascular risk factors.

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