🔍 Spontaneous Coronary Artery Dissection (SCAD) in Extreme Athletes
🔍 Spontaneous Coronary Artery Dissection (SCAD) in Extreme Athletes
Source: Medscape – May 23, 2025 | Commentary by Dr. Melissa Walton-Shirley
🧠 Case Highlight: Nicholas Troutman (Extreme Kayaker)
• 36-year-old world champion kayaker developed SCAD after days of exertional chest pain.
• Initially dismissed symptoms as caffeine or anxiety.
• Eventually diagnosed with 100% LAD occlusion due to a 36mm coronary dissection.
• Treated with aspirin, clopidogrel, and metoprolol; EF now 50%.
• Despite medical advice to quit extreme sports, he returned to competition with nitroglycerin in hand.
🩺 About SCAD (Spontaneous Coronary Artery Dissection)
• Accounts for ~4% of acute coronary syndromes (ACS); ~40% of MIs in women under 50.
• Often affects women after emotional trauma; men typically after extreme physical exertion.
• SCAD Types (Yip-Saw classification):
• Type 1: Contrast in false lumen – easier to recognize.
• Type 2a/2b: Long, smooth narrowing with or without distal involvement.
• Type 3: Mimics atherosclerosis but lacks classic features.
• Type 4: Total occlusion (as in Troutman’s case).
💊 Management & Treatment
• Medical therapy preferred unless unstable:
• Aspirin lifelong, short-term dual antiplatelets, beta-blockers.
• PCI/CABG only in specific scenarios (left main SCAD, ischemia, instability).
• Underlying conditions to assess: Fibromuscular dysplasia, connective tissue diseases, systemic inflammation, certain drugs (e.g., THC, cocaine).
🧬 SCAD Workup & Monitoring
• Requires long, detailed evaluations.
• Consider genetic testing for recurrent SCAD, male patients, family history, or multivessel involvement.
• Fibromuscular dysplasia (FMD) is a key condition to screen for.
🏃♀ Lifestyle Recommendations After SCAD
• Pregnancy: Generally discouraged unless managed by a cardio-obstetric team.
• Exercise:
• Light/moderate aerobic and strength training with low resistance encouraged.
• Avoid high-intensity, competitive sports, and activities involving strain or neck extremes.
• Avoid triggers (Valsalva, roller coasters, chiropractic manipulations).
⚠ Risk of Recurrence & Final Thoughts
• Recurrence risk: 10–20%.
• Troutman’s decision to resume kayaking illustrates patient autonomy in balancing identity and risk.
• Physicians must guide, inform, and support—even if patients take high-stakes risks.
