After experiencing acute chest pain, breathlessness, and heavy sweating while playing table tennis, the patient was rushed to Medicover Hospitals for timely intervention

He was detected with SCAD while doing coronary angiography, a rare cause of massive heart attacks. SCAD as a cause is found in less than 1% of massive heart attacks

A team led by  Dr Sameer Vankar, Consultant Interventional Cardiologist, Medicover Hospitals, Navi Mumbai, successfully treated a rare case of Spontaneous Coronary Artery Dissection (SCAD) in a 44-year-old man with no conventional heart risk factors, restoring his heart function and saving his life. The patient is now recovering well and has resumed his normal daily activities, including his table tennis. His heart function has improved, and he is free from chest pain or breathlessness.

Patient Mr. Umesh Singh (name changed), a resident of Kharghar, who runs a self-owned electronic business, was a physically fit man with no conventional heart risk factors. He was rushed to the ER at Medicover Hospitals after experiencing acute chest pain, breathlessness, and heavy sweating while playing table tennis. His electrocardiogram (ECG) confirmed a massive heart attack called an Acute Inferior wall myocardial infarction. His 2D Echo showed that his heart function was severely compromised, and the pumping of the heart was reduced to 30 % and normal pumping was in the range of 55-60%. The emergency cardiology team immediately prepared him for primary angioplasty to restore blood flow to the heart.

Dr Sameer Vankar, Consultant Interventional Cardiologist, Medicover Hospitals, Navi Mumbai, said, “On arrival in the emergency, the patient was having severe ongoing chest pain and a suffocating feeling with profuse sweating. He arrived within 4 hours of experiencing chest pain, which is well within the critical window for emergency angioplasty, medically known as Primary Angioplasty in Acute Myocardial Infarction (PAMI). The PAMI window refers to the crucial period from the onset of chest pain during which restoring blood flow through emergency angioplasty can save heart muscle and ensure the best outcomes. This window is typically within 12 hours of symptom onset; the earlier the intervention, the better the results. His Coronary angiography showed a 100% blockage in the mid-right coronary artery with a total thrombotic occlusion. Initial attempts with a thrombectomy device and a 2 mm balloon failed to restore normal flow, raising suspicion of Spontaneous Coronary Artery Dissection (SCAD), a rare cause of massive heart attack. SCAD is a tear in the heart artery wall, causing symptoms like chest pain, shortness of breath, and rapid heartbeat.”

Spontaneous Coronary Artery Dissection (SCAD) is a condition wherein the inner layer of the coronary artery tears, thus forming extra (false) passages within the arterial wall in addition to the original true passage in the artery, which carries blood and supplies the muscles of the heart. Blood enters these extra passages from the main passage, but does not flow freely. Instead, the blood keeps on accumulating in these false passages, expanding its size, thus resulting in complete occlusion of the true passage and stopping blood from reaching the heart muscles. Unlike a blood clot formed in the true passage of cholesterol deposited (atherosclerotic) arteries, which is a common cause of massive heart attack, SCAD occurs in less than 1 in 1,000 acute heart attack cases.

Causes of SCAD could be inherent weakness in the arterial wall seen in conditions such as Fibromuscular dysplasia, Marfan syndrome, Ehlers-Danlos syndrome, and female hormonal effects during pregnancy. It can also be triggered by extreme strenuous exercises, emotional stress, and illicit drugs such as cocaine. SCAD can be confirmed with the help of intravascular coronary imaging, such as Intravascular Ultrasonography (IVUS) or Optical Computed Tomography (OCT). It is more common in younger women less than 50 years of age, but here it was seen in a healthy middle-aged man, which is rare. SCAD is commonly seen in the left arteries of the heart, but in this case, it involved the right heart artery, thus making it more unique and further rarer in its incidence.

Dr Sameer Vankar further added, “The main challenge was ensuring the wire stayed in the true artery passage, as stenting in the false passage could have permanently blocked blood flow. Once the flow was restored, we maintained it with continuous intravenous injection and reassessed after 24 hours. On Day 2, using OCT (Optical Coherence Tomography) imaging, we confirmed the wire was in the true passage and proceeded with successful stenting. The procedure revealed a long, healthy right coronary artery supplying a large portion of the heart. The patient experienced immediate relief from chest pain and breathlessness. Day 1 of the procedure took 60 minutes, while Day 2, including OCT guidance, was completed in 45 minutes. The patient was discharged on the third day post-stenting. At his 1-week follow-up, the patient was pain-free with only mild exertional breathlessness. By 4 weeks, he had no chest pain or breathlessness and had resumed table tennis. Repeat ECHO showed heart function improvement from 30% to 50%. He was advised to monitor symptoms like chest pain, breathlessness, swelling, palpitations, and postural dizziness, and to limit salt intake during recovery.”

The key to success was patience, planning, and using OCT to guide safe stenting. If left on medical management, his heart function could have worsened significantly. Medicover Hospitals is well-equipped to handle rare and complex heart conditions with advanced facilities and expert cardiac teams. Its cutting-edge technology ensures timely, precise, and life-saving interventions for patients.

“I never imagined something like this could happen to me, especially since I’ve always been active and healthy. While playing table tennis, I suddenly felt immense chest pain, struggled to breathe, and started sweating heavily. It was terrifying. Within minutes, I was rushed to the hospital, not knowing if I would make it. I am deeply grateful to Dr Vankar and his team for their quick thinking, expertise, and care that truly gave me a second chance at life,” concluded the patient, Mr. Umesh Singh (name changed).