Spontaneous coronary artery dissection should be considered in the differential diagnosis for young individuals presenting with exercise-related acute ischemic cardiac events, though evidence for return-to-play guidelines remains absent.
SCAD merits consideration in young athletes with exercise-related ischemia; leaves open evidence-based return-to-play guidance.
BACKGROUND: Spontaneous coronary artery dissection is a rare cause of acute cardiac events and occurs most frequently in the peripartum period. Coronary artery dissection related to exercise is even more unusual, with only a few cases reported in the literature. We report a case of acute coronary artery dissection related to exercise in a 17-yr-old high school athlete, and we review the available literature on exercise-related coronary dissection. METHODS: 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.
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Kalaga et al. (2007) studied this question.