Abstract / Summary
Abstract Background Spontaneous coronary artery dissection (SCAD) is a tear in the wall of a coronary artery that is characterized by its sudden onset, occurring independent of trauma or atherosclerosis. Most probable precipitants of SCAD are thought to be caused by increases in sympathetic stimulation, suggesting that other causes of sympathetic discharge may also precipitate SCAD. Cold drink ingestion increases sympathetic tone via a pharyngeal pressor response, making it a plausible precipitant of SCAD. Cold drink as a SCAD trigger, however, has not been described in the literature. We report a case of a patient with two distinct episodes of de novo SCAD, each occurring during ice-cold drink ingestion. Case presentation A 46-year-old female without a history of cardiovascular disease was admitted to the hospital twice within 3 days with mid-sternal burning chest pain radiating into both forearms. During the first visit, symptoms occurred while rapidly drinking an ice-cold beverage. A 12-lead electrocardiogram in the emergency department revealed ST-segment depression in leads V3-V5. Her serum troponin level was elevated. Coronary angiography identified de novo SCAD in a distal acute branch of the right coronary artery with newly identified fibromuscular dysplasia in the right external iliac artery. She was treated conservatively and discharged home. She returned 30 h later with renewed onset of symptoms after rapidly drinking an ice-cold beverage. She was found to have an ST-segment elevation myocardial infarction. Repeat coronary angiography identified a new SCAD in the mid-left circumflex coronary artery. Recovery after the second discharge was unremarkable, with no further cardiovascular sequelae over the ensuing 10 years. Conclusions This case report generates the hypothesis that cold drink ingestion may trigger SCAD in susceptible patients. SCAD can be a frightening diagnosis for patients who may not know what caused the dissection or how to prevent recurrence. Clinicians caring for patients with SCAD should inquire about possible triggers and educate their patients on trigger avoidance. Confirmatory research is needed from observational studies before cold drink ingestion can be classified as a probable SCAD trigger.