CAD in a patient with fatigue and episodic retrosternal burn
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. The present case has been reported in the European Heart Journal - Case Reports.

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.

The patient was followed 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.

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.

Learning points
• In a patient with acute chest pain without any cardiovascular risk factor always think about rare conditions such as spontaneous coronary artery dissection (SCAD).

• Para-clinic results such as unremarkable electrocardiogram and normal multislice computed tomography angiogram does not rule out SCAD.

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