A 25-Year-Old Man’s Heart Artery Tear Exposed a Rare Saw-Tooth Heart Muscle, a Pairing Doctors Say Is a First

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Cardiologists at the Gold Coast Hospital and Health Service in Queensland diagnosed spontaneous coronary artery dissection, or SCAD, together with saw-tooth cardiomyopathy, which they described as “an exceptionally rare form of left ventricular dysplasia.” In their report in JACC: Case Reports, published in September 2026, the authors say the two conditions had not been reported together before.

The case is unusual twice over. SCAD overwhelmingly strikes women, and saw-tooth cardiomyopathy has been described in only a handful of patients worldwide.

Most heart attacks happen when fatty plaque ruptures inside a coronary artery and a clot forms. SCAD works differently. A tear or bleed develops in the artery wall itself, creating a flap or bruise that narrows the vessel and cuts off blood flow.

The young man’s electrocardiogram showed ST-segment elevation, the pattern doctors associate with a major heart attack. He also developed cardiogenic shock, in which the heart cannot pump enough blood to meet the body’s needs, along with fluid in his lungs. Coronary angiography confirmed the dissection.

His care team managed him conservatively with guideline-directed medications. That approach is common in SCAD, because torn arteries often heal on their own and procedures on a fragile, dissected vessel carry their own risks.

Cardiac MRI showed extensive damage to the heart muscle from the heart attack. It also revealed the serrated features of saw-tooth cardiomyopathy.

The condition was first described in 2009, when doctors in Greece reported a 2-month-old boy whose heart scans, done after a murmur was heard, showed saw-tooth-like projections reaching into the left ventricle. A 2022 review in Reviews in Cardiovascular Medicine counted just 10 reported cases in the condition’s first decade. Eight of the 10 patients were male, and the average age at diagnosis was about 36. Presentations ranged from no symptoms at all to acute heart failure, and weakness of the left ventricle was the most common complication, seen in 80% of patients.

Researchers still debate whether saw-tooth cardiomyopathy is a distinct disease or a subtype of left ventricular noncompaction, a condition in which the heart muscle develops an abnormal spongy layer.

The Australian team did not conclude that the artery tear created the serrated muscle. Instead, multiple imaging methods helped them separate the acute damage from the heart attack from a structural abnormality that was most likely already there. Their takeaway: a sudden artery tear can unmask structural heart problems that had gone unrecognized.

Extended genetic testing came back negative, and the authors did not propose a shared cause linking the two conditions. That fits broader SCAD research, which has found that known genes for inherited connective tissue disorders and aortic disease, such as those behind Marfan and Ehlers-Danlos syndromes, explain only about 5% to 9% of cases.

The patient’s profile adds to the intrigue. According to a 2020 review in the Journal of the American College of Cardiology, women make up 87% to 95% of SCAD cases, and SCAD causes up to 35% of acute coronary syndromes in women 50 and younger. Pregnancy and fibromuscular dysplasia, a disorder of the walls of medium-sized arteries, are among the conditions linked to it.

The Mayo Clinic notes that SCAD most commonly affects women in their 40s and 50s but can occur in men. A 25-year-old man falls well outside the usual pattern.

The American Heart Association says SCAD patients usually have few or no risk factors for heart disease, which is one reason it can be overlooked in younger people.

The outcome was sobering. Follow-up showed that the pumping function of his heart remained impaired, according to the report.

That contrasts with the usual SCAD course. An August 2025 American College of Cardiology feature noted that blood flow improves or normalizes in 70% to 95% of conservatively managed patients, and in-hospital death rates run about 1% to 2%. But SCAD returns in roughly 10% to 20% of patients over extended follow-up, one reason survivors need ongoing cardiology care.

The authors said the genetic basis and long-term outlook of saw-tooth cardiomyopathy remain uncertain and called for long-term follow-up. Earlier reports have linked the condition with heart failure, rhythm problems, blood clots, and mitral valve prolapse.

Because the report describes a single patient, it cannot show whether saw-tooth cardiomyopathy raises the risk of SCAD. Its main value is diagnostic: a dramatic event like an artery tear can expose a second, rarer problem that might otherwise stay hidden.

Anyone with sudden chest pain, shortness of breath, sweating, or pain spreading to the arm, jaw, or back should call 911, regardless of age or sex.

What is spontaneous coronary artery dissection?

SCAD is a tear or bleed in the wall of a heart artery that can block blood flow and cause a heart attack, often in people without clogged arteries.

It is an extremely rare heart muscle abnormality in which the wall of the left ventricle shows jagged, saw-tooth-like projections on imaging.

The authors say the two conditions had not been reported together, and the patient was a 25-year-old man, while SCAD mostly affects women.

Did the artery tear cause the saw-tooth pattern?

The doctors concluded the saw-tooth abnormality was most likely already present and was revealed during imaging for the heart attack.

SCAD is uncommon, but it can strike young people with few risk factors. Anyone with heart attack symptoms should seek emergency care immediately.