ABC | Volume 113, Nº5, November 2019

Viewpoint Souza & Herdy Exercise-related SCAD in young people Arq Bras Cardiol. 2019; 113(5):988-998 Figure 3 – Evident dilation of right coronary artery on transthoracic echocardiogram at rest. Figure 4 (A and B) – Cardiac catheterization: extensive thrombosis in the right coronary artery. A B ago, in a retrosternal location, which improved after use of acetaminophen at home, and remained, on arrival at the emergency, continuous and poorly defined. When performing a physical examination he was hypertensive, with a high level of diastolic blood pressure (170/140 mmHg). An ECG was performed, which showed no acute changes. There was an increase in MNM, and he was diagnosed with a new STEMI and measures for ACS with consequent stratification to perform a new CATE that, once again, showed thrombosis in SCAD, without collateral circulation for SCAD from the left coronary (Figures 6 and 7). He underwent TCA, with dilation and aspiration of intraluminal thrombi. During hospitalization, atypical chest pain was felt two days after CATE. Coronary angiotomography (CT angiography) with zero calcium score was performed, which disregarded atherosclerotic lesions. The patient was discharged 10 days after hospitalization and prescribed daily warfarin 5 mg; clopidogrel 75 mg and Ramipril 5 mg. Other causes of coronary obstruction were disregarded in an in-hospital investigation. Remains on medication and performs high intensity physical activities to this day; remains asymptomatic. Case 2 Patient E.P.N, male, 29 years old, professional soccer athlete, without risk factors for early CAD, without previous use of anabolic, ergogenic, illicit or anorectic drugs. Negative family history for coronary heart disease, cardiomyopathy or thrombotic disease. He sought medical attention because of 991