Spontaneous coronary artery dissection - a diagnosis to be considered in young patients presenting with acute myocardial infarction.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and sudden death. Various therapeutics strategies have been proposed, from conservative management to surgical or percutaneous revascularization. Standard therapy has not been yet established. We report a case of a 34-year-old athlete, presenting chest pain after intense physical activity. Once the clinical and laboratory findings were typical of an acute coronary syndrome, the patient underwent cardiac catheterization, which showed right coronary artery dissection. Initially, conservative management was established, but, after 72 hours of no pain relief, a percutaneous stent implantation procedure was implemented resulting in a complete angiographic and clinical response. This case and review of literature emphasize that although SCAD is a very rare entity, it must be kept in mind in the differential diagnosis of acute, sharp chest pain in young physically active individuals, with no apparent risk factor for coronary artery disease.