Key result
Conservative management with dual antiplatelet therapy and enoxaparin resolved symptoms and improved LVEF from 35% to 40% in a 21-year-old man with circumflex artery SCAD and monomorphic VT.
Why the study?
Spontaneous coronary artery dissection predominantly affects young women and is markedly less common in men, with recognized triggers including conditions that acutely raise intrathoracic pressure such as severe coughing.
Case Report (n=1)
No
This case highlights that spontaneous coronary artery dissection (SCAD) should be considered in young men presenting with chest pain and ventricular arrhythmias following severe coughing, and demonstrates successful conservative medical management in accordance with current guidelines.
Hypothesis-generating for conservative management in young men with SCAD and VT; prospective studies needed before clinical adoption.
Background: Spontaneous coronary artery dissection (SCAD) accounts for approximately 5% of myocardial infarction (MI) cases and predominantly affects young women without traditional cardiovascular risk factors; it is markedly less common in men. Recognized triggers include severe physical exertion, emotional stress, and conditions that acutely raise intrathoracic pressure, such as severe coughing. Case Presentation: A 21-year-old male was hospitalized with a preliminary diagnosis of pneumonia after severe coughing episodes. He had recently started tirzepatide for obesity. During hospitalization he developed chest pain and tachycardia; an electrocardiogram (ECG) captured monomorphic ventricular tachycardia (VT), and a repeat ECG after rate control showed inferior ST-segment elevation. Echocardiography revealed a left ventricular ejection fraction (LVEF) of 35%. Coronary angiography demonstrated spontaneous dissection of the circumflex artery (CX) without atherosclerotic disease elsewhere. The patient was managed conservatively with dual antiplatelet therapy and enoxaparin, remained free of recurrent symptoms, and was discharged with an improved LVEF of 40%. Conclusion: SCAD should be considered in young men presenting with chest pain or arrhythmia after severe coughing, even without classic cardiovascular risk factors. The co-occurrence of CX-related SCAD, inferior ST-elevation myocardial infarction (STEMI), and monomorphic VT is rarely reported and raises the possibility of Purkinje-related arrhythmogenesis in this territory, a mechanism warranting further study.
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Ersin et al. (2026) conducted a case report in Spontaneous coronary artery dissection (SCAD) of the circumflex artery presenting with inferior STEMI and monomorphic ventricular tachycardia (n=1). Conservative medical management (acetylsalicylic acid, clopidogrel, and enoxaparin sodium) was evaluated on Left ventricular ejection fraction (LVEF) improvement and symptom resolution at discharge. Conservative management with dual antiplatelet therapy and enoxaparin resolved symptoms and improved LVEF from 35% to 40% in a 21-year-old man with circumflex artery SCAD and monomorphic VT.
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