ABC | Volume 113, Nº5, November 2019

Viewpoint Souza & Herdy Exercise-related SCAD in young people Arq Bras Cardiol. 2019; 113(5):988-998 In this sample, all presented chest pain or dyspnea, with recurrence of symptoms. These pictures suggest the formation of thrombi with varying degrees of stenosis, often with spontaneous resolutions and recurrence. These manifestations also suggest an endothelial mechanical lesion with thrombus formation at the injured endothelium site, as occurred in Case 1, with thrombus recurrence after years at the same site. ADA is usually the most commonly affected artery in SCAD, and the incidence of SCAD ranges from 0.07% to 0.1% of patients undergoing coronary angiography. 1-16 Although the literature suggests a better prognosis with conservative treatment (without stenting ) and that ADA is the cause of most cases of SCAD, SCAD involvement was described in two of the three cases in this article. One of these two reported cases, both conservatively treated with balloon dilation and thrombus aspiration, had recurrence of thrombosis in the same artery five years later, in a similar situation, that is, after intense physical exercise, and the patient treated with ATC and a armacological stent remained asymptomatic, practicing moderate to intense physical activity until the present moment. Two patients were discharged with the prescription of dual antiplatelet therapy (DAPT), statin and a beta-blocker. One patient started using angiotensin‑converting enzyme inhibitor (ACEI) and did not receive DAPT upon discharge due to being allergic to AAS. The use of heparin and DAPT in DEAC is still controversial. 1 The use of beta-blockers is recommended, and ACE inhibitors remain uncertain in these cases. 29.30 Technological advances will enable more accurate diagnoses of SCAD among those with symptoms of coronary insufficiency or ACS. However, the pathophysiology of exercise-related SCAD is complex and still poorly understood, leading to conditions with variable and often subacute clinical presentations, which, in addition to the severity and therapeutic urgency, especially in an emergency setting, are often underdiagnosed. The current diagnostic difficulty and the lack of studies directed to the specific treatment of this disease stimulate further studies and therapeutic proposals for exercise-related SCAD. Conclusion Case reports such as these are extremely important, since better knowledge of the clinical conditions and presentation aims to increase the suspicion of exercise-related SCAD. Future studies directed to the diagnosis and treatment of this pathology are necessary. In addition, it is necessary to alert the medical community about this possible cause of ACS among chest pain conditions in male patients without risk factors and practicing physical activities. Author contributions Conception and design of the research, Acquisition of data, Analysis and interpretation of the data and Critical revision of the manuscript for intellectual content: de Souza P, Herdy AH; Writing of the manuscript: de Souza P. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 1. Hayes SN, Kim ESH, Saw J, Adlam D, Arslanian-Engoren C, Economy KE, et al. Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association. Circulation. 2018;137(19):e523-57. 2. Adlam D, Olson TM, Combaret N, Kovacic JC, Iismaa SE, Al-Hussaini A, et al. 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