Heavy Lifting Causing Spontaneous Coronary Artery Dissection with Anterior Myocardial Infarction in a 54-Year-Old Woman

Abstract

Spontaneous coronary artery dissection in association with strenuous exercise and weightlifting is rather sparsely described in the medical literature. Diagnosis S pontaneous coronary artery dissection (SCAD), a rare cause of myocardial infarction (MI) and sudden cardiac death, can present with various acute coronary symptoms. It usually occurs in the peripartum period. In association with strenuous exercise and heavy lifting, SCAD is rather sparsely documented in the medical literature. We report the case of a patient in whom heavy lifting caused SCAD, and we review the literature on this topic. Case ReportIn January 2014, a 54-year-old woman had acute-onset retrosternal chest pain immediately after gardening and disposing of a heavy basket of cut grass. She had a normal body weight, no relevant medical history, and no known risk factors for coronary artery disease. She was 4 years postmenopausal. After an hour of worsening pain, she presented at the emergency department, having experienced cardiac arrest and resuscitation en route. After she was intubated, an electrocardiogram (ECG) showed ST-segment elevation in leads V 2 through V 5 , so she underwent thrombolysis. The patient's troponin T level was elevated at 0.4 ng/mL. The next day, her ECG results were consistent with anterior MI. Coronary angiograms revealed a spiral dissection of the left anterior descending coronary artery (LAD) (Fig. 1), which was successfully treated by means of angioplasty and the implantation of 3 drug-eluting stents. The rest of the coronary tree was smooth. The patient was discharged from the hospital after an uneventful 6-day stay, with instructions to take aspirin, prasugrel, a β-blocker, and a statin. Seven months later, results of an exercise ECG were normal, and the patient had returned to normal activity and full-time work. DiscussionCoronary artery dissection refers to the splitting of the arterial wall layers, the result of which is a false lumen. This dissection can occur spontaneously; after chest trauma, percutaneous coronary intervention, or cardiac surgery; or as part of aortic dissection. Accumulated blood in the false lumen can encroach on the true lumen, thereby impairing blood flow and causing myocardial ischemia, MI, or sudden cardiac death. [1][2][3][4][5] Since the first description of SCAD, 6 approximately 320 documented cases have been reported. This figure might be misleading, because many of the reports were Case Reports

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

“…13,223 As a result, and with the potential for physical and mental harm, some patients with SCAD continue to receive advice to severely restrict their activities such as to avoid lifting >10 lb or not to pursue activity beyond limited walking, 220 which could place them at the risks associated with a sedentary lifestyle. Many patients had high levels of physical activity before their first SCAD event and express high levels of motivation to resume those activities.…”

Spontaneous coronary artery dissection

“…SCAD may be precipitated by Valsalva-type manoeuvres such as coughing,14 vomiting,15 heavy lifting16 or by extreme or isometric exercise 17–19. It is hypothesised that this results from transient increases in coronary wall shear stress.…”

Chylothorax due to weight lifting: a rare etiology

“…Several different and rare diseases have been reported in association with weight liftings, such as pneumothorax, pneumomediastinum, or dissection of the coronary artery. [10][11][12] Therefore, athletes and physicians must remain aware of these issues and the extraordinary symptoms that may occur during and after this kind of exercise.…”