ABC | Volume 113, Nº5, November 2019

Viewpoint Souza & Herdy Exercise-related SCAD in young people Arq Bras Cardiol. 2019; 113(5):988-998 Figure 10 – CT angiography: proximal obstruction of the anterior descending artery that receives collateral circulation of the right coronary artery and the circumflex coronary artery. (<1%). This analysis confirms that SCAD has a heterogeneous pathophysiological basis, in addition to the traditional causes of ACS. Smaller studies had previously described these conditions as a cause of SCAD. However, this was the first research to demonstrate that only genetic vasculopathies (Marfan and Ehlers-Danlos syndromes), fibromuscular dysplasia, the use of steroids and corticosteroids, migraine and some autoimmune and inflammatory conditions are more prevalent in ACSD through SCAD Than those not caused by spontaneous dissections. 14 Fibromuscular dysplasia, for example, etiology frequently associated with SCAD in the literature and recently published its link to the genetic variant of the PHACTR1/DN1 allele rs9349379-A as the first identifiable genetic risk factor for SCAD, 2 and it was prevalent in only 0, 16% of all cases analyzed. 14 The age of the patients evaluated ranged from 20 to 31 years old, all male who practiced predominantly strong aerobic physical activity, one of themwas a professional athlete and the other were amateurs. While describing the case of a 54-year-old male patient with SCAD with no risk factors or CAD, Ellis et al. found 13 reports of exercise-related SCAD cases between 1995 and 2014 .20 Nine of these patients were male and the average age was 36 years, ranging from 17 to 53 years. Among these, seven cases (53.8%) were associated with aerobic activity and 5 cases (38.4%) were associated with anaerobic activity. Another case was also associated with severe emotional stress and anxiety. Most reported SCAD cases had risk factors or were diagnosed as atherosclerosis on the angiography, Figure 11 – Cardiac catheterization: thrombosis in the right coronary artery. 995