Galilee Doctors Save Man from Rare SCAD Heart Attack Induced During Sex
Doctors at the Galilee Medical Center saved a man in his 40s who suffered a rare spontaneous coronary artery dissection during sexual activity, utilizing an innovative off-label cutting balloon procedure.
A man in his 40s was rushed to the Galilee Medical Center after suffering severe chest pain during morning sexual activity. An emergency crew arriving at the scene performed an ECG, identifying signs of a severe heart attack, and he was urgently evacuated to the hospital. While en route, the catheterization unit was notified. Upon arrival, he was immediately taken to the cath lab, but his condition deteriorated rapidly, requiring three resuscitations including electric shocks due to cardiac arrest.
During the procedure, it became clear this was not a routine heart attack. "In the vast majority of heart attacks, we see atherosclerosis—a buildup of fats, cholesterol, and other substances on the artery wall," explains Dr. Haytham Sholy, director of the catheterization unit (interventional cardiology) at the Galilee Medical Center. "In his case, we found something completely different known as SCAD—Spontaneous Coronary Artery Dissection. This is a rare condition, and it is even rarer to see it in men."
A Rare Condition and Critical Treatment
SCAD occurs when a separation forms between the layers of the artery wall; blood penetrates and accumulates within the wall until it presses on the lumen through which it is supposed to flow, potentially blocking it. Dr. Sholy noted that the tear occurred in the left anterior descending artery (LAD), a primary vessel supplying blood to the heart muscle. The procedure was guided largely by IVUS, an intravascular ultrasound imaging test showing the arterial wall from the inside, which revealed the tear extended back to the left main coronary artery.
The patient's critical condition did not allow for surgical delay. Stents could have worsened the situation by pushing accumulated blood into additional areas along the artery. Dr. Sholy decided to perform an exceptional procedure using a cutting balloon—a catheter balloon featuring tiny blades, typically used for severe arterial stenoses. The team used the blades to create openings in the tissue separating the true lumen from the false lumen, allowing the accumulated blood to drain back into the artery and relieving the pressure.
«This is essentially 'off-label'—using technology for a purpose other than intended,» explains Dr. Sholy. «There are rare cases described worldwide, but this technique has not yet been used for this purpose in Israel. Fortunately, it worked exceptionally well, restoring blood flow and saving his life.»
Sexual Activity as a Trigger
While heart attacks during sexual activity are a documented phenomenon, Dr. Sholy emphasizes that this case is exceptionally unusual due to the patient's relatively young age, gender, and specifically the underlying cause. During sexual activity, changes occur in heart rate and blood flow, exerting shear forces on blood vessels. In an individual with a pre-existing vulnerability in the arterial wall, these forces can act as a trigger for a tear. Furthermore, the event occurring during morning hours may be relevant, as physiological changes during this time increase cardiovascular activity.
