Coronary artery dissection in a 33-year-old man with fatigue and episodic retrosternal burning: a case report

Abstract

Background Non-atherosclerotic spontaneous coronary artery dissection (SCAD) is a rare disease that predominantly affects women. It presents with acute chest pain, ventricular arrhythmias, and even sudden cardiac death. Case Summary A 33-year-old man presented to emergency department with fatigue and cold sweat. He had no complaint of chest pain at the time of admission. He experienced a retrosternal chest pain 2 days ago after lifting a 30 pounds weight in the gym. Para-clinic results such as coronary computed tomography angiography and electrocardiogram were normal. However, coronary angiography showed multiple coronary dissections. We followed the patient for 4 months. He was asymptomatic except for one episode of chest pain during Tehran earthquake, while he was carrying his child to escape the room. Follow-up myocardial perfusion scan was negative for ischaemia. Discussion Stressors such as intense exercise, emotional stress, and Valsalva manoeuvre may cause SCAD in otherwise healthy patient. As in our case, lifting heavy weights was the most likely reason for SCAD. Stable patients without ongoing chest pain will be followed conservatively.

Extremely Heavy Lifting Associated With Spontaneous Coronary Artery Dissection

“…At least three other case reports describe patients who began experiencing chest pain after heavy lifting. One case involved an otherwise healthy 33-year-old lifting 30-pound weights at the gym when he began experiencing retrosternal chest pain [ 7 ]. Another man with no underlying health problems presented with chest pain after sexual activity after having repeatedly lifted greater than 50 pounds of weight two days prior and was found to have SCAD [ 8 ].…”

Wild at heart: 34-year-old male with new onset dyspnea, heart failure and history of amphetamine use; a case report

“…Spontaneous coronary artery dissection (SCAD) is a rather rare cause of acute coronary syndrome (ACS) with a preponderance for young female patients [1]. Up until this point, less than 800 cases of SCAD have been reported in literature since 1931 [2] and while most of these reports have focused on SCAD’s ACS and sudden cardiac death (SCD) presentations it is obvious that the real numbers are much higher, the reason for this underdiagnose being SCAD’s challenging and often disparate symptoms in young patients with otherwise no coronary artery disease risk factors [3, 4]. Amphetamines are now the second most widely used substance drugs in the world and they are associated with a myriad of cardiac diseases from hypertension to tachycardia to fatal arrhythmias to coronary, carotid, and aortic dissections to cardiomyopathies to death [5].…”