Spontaneous Coronary Artery Dissection

Normal health 58 yr old pickleball player

May 17, 2023

I’m a healthy 58 year old woman. I worked with my husband for several hours lifting, pushing and pulling heavy objects in my husband’s car barn on during morning to early afternoon Sunday, April 23, 2023. Monday morning, I played pickleball for 2-3 hrs. Monday evening I had a sharp chest pain with numbness down to my elbows. Took two antacids and an aspirin. Pain dissipated after about 20 min but still felt off. Husband was out of town so drove to nearest hospital only to find out blood enzymes were elevated, indicating heart attack.

Cath diagnosis was SCAD, 50 percent occlusion and minor damage to heart that may resolve with reinstated blood flow. Otherwise, vessels were “clean as a whistle”. No stent required. High “bad” cholesterol and also high on Lipoprotein A, aka Lp(a), an indicator of familial cholesterol issues. Put on beta blocker Metoprolol, aspirin and statin and sent home Tuesday midday (my 58th bday).

Second heart attack occurred Wednesday morning and was more severe. Sharp pain in chest, “fluttering” down to fingertips, pain in neck and jaw. Transported back to hospital, EKG showed issue was same artery so no repeat Cath and therefore I was not sure if tear was made worse. Kept for observation to Sunday and added Plavix to medications. Side note: While in emergency the second time, an IV was inserted in my right elbow that hurt worse than the heart attack, right down to the fingertips. It was pulled and reinserted. 2 weeks later back to emergency for ultrasound and was diagnosed with superficial vein thrombosis in the right arm. Currently finishing antibiotic for the vein clot and am three weeks out from second heart attack, arm doing much better. Can’t wait to finish antibiotic as mouth now has nasty metal taste and food/drink tastes awful.

Initially I was as fatigued more than I thought was normal and found that Metoprolol caused fatigue; moved taking it to evening. Will start cardiac rehab in another week and will be anxious to play pickleball again but worried about sudden bursts of energy playing. Will also be cautious about lifting heavy items and will be working on cholesterol issues for long term. Not sure what actually caused my SCAD; if it was heavy work on Sunday why not a heart attack then or did it take a while to build up the arterial bulge? Why nothing during pickleball? Does Monday evening mean I did something during pickleball or was it that long to fully develop from Sunday?

May never know but now a bit scared (don’t want to be) about playing pickleball again. Hope to also get off Plavix since it’s not typical for SCAD, and will be asking to get off Metoprolol and baby aspirin and stay on statin, but guessing drs will want me on them for a bit to avoid reoccurrence of SCAD.. Lastly: I do not have aneurisms or connective tissue disease and it is not known at this time if or how much high cholesterol may have played a role in having this SCAD happen.