Intense exercise may not be so benign: chest pain in a young athletic woman may be spontaneous coronary artery dissection (SCAD).

We present a 26-year-old woman who came to the emergency department with chest pain of 1 hour duration that started while she was exercising on the treadmill. At presentation, ECG showed sinus bradycardia. Initial troponin level was 0.05 ng/mL and her chest pain resolved within 3 hours of onset. Troponins were trended serially, which continued to rise and peaked at 28.77 ng/mL and so heparin drip was started. On the second day of admission, a coronary angiogram was performed along with intravascular ultrasound, which revealed type 3 spontaneous coronary artery dissection. No obstructive atherosclerotic disease was noted in any of the coronary vessels. No coronary intervention was performed. Patient was started on aspirin and clopidogrel. Patient was discharged home in stable condition and was followed outpatient, where she remained in excellent health condition at her first clinic visit. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.