Exercise-Related Spontaneous Coronary Artery Dissection

Abstract

We performed a PubMed literature search using the search terms exercise, sports, spontaneous coronary dissection, and athletics. We found seven cases of spontaneous coronary artery dissection that had occurred during intense physical exercise. Vigorous exercise can provoke acute ischemic events, but such events occur primarily in adults with atherosclerotic disease. Many of the cases reported as spontaneous coronary artery dissection are more likely atherosclerotic plaque rupture, in which cases they are not truly spontaneous. Because spontaneous coronary dissection is so rare, there are no available recommendations on how to manage young athletes with this condition. We permitted this athlete to return to limited competition, without data to support either a total restriction or even a limited restriction, with the written understanding that a recurrent event is possible but probably unlikely. In summary, spontaneous coronary artery dissection should be considered in young individuals presenting with exercise-related acute ischemic cardiac events.

Exercise-induced coronary artery dissection in a 54-year-old male without atherosclerosis: A case report

“…Nine of these patients were male and the mean age at the time of dissection was 36 years of age ranging from 17 to 53 years. The risk factors each patient had were analyzed; 30.7% were smokers, 30% had high cholesterol and 15.3% had a family history of ischemic heart disease [1,[3][4][5][6][7][8][9][10][11][12]. Obesity was identified as a further risk factor in one of these patients [5].…”

“…From literature reviewed, seven cases (53.8%) were associated with aerobic activity and five cases (38.4%) were associated with anaerobic activity disease [1,[3][4][5][6][7][8][9][10][11][12]. One further case that was found was associated with severe emotional distress and anxiety [3].…”

“…There is debate as to whether this group has truly had spontaneous coronary artery dissection because of the underlying weakness in the artery wall predisposing them to SCAD [6,17]. Tweet et al suggest that plaque dissection may well represent a differing presentation of typical acute coronary syndrome and that non-atherosclerotic SCAD is clinically separate [15].…”

Eligibility and Disqualification Recommendations for Competitive Athletes with Cardiovascular Abnormalities: Task Force 8: Coronary Artery Disease

“…13 Spontaneous coronary artery dissection is associated with late pregnancy and the peripartum state, female hormonal therapy, Marfan syndrome, exercise, chest trauma, 13 and fibromuscular dysplasia.…”

Peculiarities of Coronary Artery Disease in Athletes

“…Another possible pathophysiological mechanism is the occurrence of spam (Hiltgen et al, 1989) and could explain the case N° 7 of our study. Few cases of spontaneous coronary dissection (Kalaga et al, 2007) and congenital coronary artery anomalies (Corrado et al, 1998) are also reported but concern young athletes with a different pathophysiological mechanism.…”