A 46-year-old woman with no history of heart disease felt a burning pain in the middle of her chest that spread into both forearms. It began while she was rapidly drinking an . Doctors found a tear inside one of her heart arteries.
She was treated and sent home. Thirty hours later, she was back with the same symptoms, again after rapidly drinking an ice-cold beverage. This time she was having an ST-elevation heart attack, the more severe type, and a second artery had torn.
Physicians and researchers in California, including members of Kaiser Permanente’s CREST research network, published the case in on Oct. 1, 2026. They write that a cold drink as a trigger for spontaneous coronary artery dissection (SCAD) “has not been described in the literature.”
Two Tears in Two Different Arteries
SCAD happens when a tear or bleed forms inside the wall of a coronary artery, narrowing or blocking blood flow to the heart. Unlike most heart attacks, it is not caused by cholesterol plaque.
At her first visit, her electrocardiogram showed ST-segment depression, and her troponin level, a marker of heart muscle damage, was elevated. Coronary angiography found a new dissection in a small branch at the far end of her right coronary artery. Imaging also revealed fibromuscular dysplasia (FMD), a disorder of the artery walls, in her right external iliac artery, which supplies the leg. She had not been diagnosed with it before.
She was treated conservatively and discharged. On her return, she had an ST-elevation myocardial infarction (STEMI). A repeat angiogram showed a new dissection in the middle of a different artery, the left circumflex.
According to the report, her recovery after the second discharge was “unremarkable,” with no further cardiovascular problems over the following 10 years. That long follow-up means the events themselves took place about a decade before the report was published.
A Reflex in the Throat
Doctors have long suspected that surges in adrenaline-driven, or sympathetic, nervous activity set off many SCAD episodes. A 2020 review in the noted that precipitating factors, most commonly extreme physical or emotional stress, have been linked to SCAD onset in as many as two-thirds of patients.
The authors suggest that cold drinks could act through a similar pathway. They write that “cold drink ingestion increases sympathetic tone via a pharyngeal pressor response,” a reflex in which cold in the throat raises blood pressure. In their view, that makes a cold drink “a plausible precipitant of SCAD.”
Cold is a known stressor for blood vessels. In the cold pressor test, a research tool for studying artery function, a person’s hand and forearm are immersed in ice water. A explains that healthy coronary arteries normally widen during the test, but diseased ones may paradoxically narrow, with the response to cold occurring in about a minute.
Senior author David R. Vinson has studied cold triggers before. In 2025, his team reported that some people with atrial fibrillation had episodes set off by ice water, smoothies, milk, yogurt or ice cream, in a . Most participants who avoided cold foods and drinks reported fewer or no episodes. That work involved a heart rhythm problem, not artery tears.
Who Gets SCAD
SCAD mainly affects women. The JACC review notes that single-center studies have found it causes up to 35% of acute coronary syndromes in women 50 and younger, though population-based estimates are much lower. The says SCAD most commonly affects women in their 40s and 50s. Risk factors it lists include childbirth, especially the first weeks after delivery, intense exercise, severe emotional distress, FMD, some inherited connective tissue disorders, very high blood pressure, and illicit drugs such as cocaine.
The patient in this report had one of those risk factors. The notes that many SCAD patients also have FMD, and that people who have had SCAD are at high risk of another.
Her vulnerable arteries are an important part of the story. If cold drinks play any role, the authors suggest it would be “in susceptible patients,” not in the general population.
A Hypothesis, Not a Warning Label
The researchers are careful about what one case can show. They conclude that the report “generates the hypothesis that cold drink ingestion may trigger SCAD in susceptible patients.” They add that “confirmatory research is needed from observational studies before cold drink ingestion can be classified as a probable SCAD trigger.” The case does not show that cold drinks cause heart attacks.
Their recommendations are for doctors. “SCAD can be a frightening diagnosis for patients who may not know what caused the dissection or how to prevent recurrence,” they write. They urge clinicians to “inquire about possible triggers and educate their patients on trigger avoidance.”
For SCAD survivors, the practical question is whether any personal pattern exists. Anyone with sudden chest pain, pain spreading to the arms, shortness of breath or sweating should call 911. People with a history of SCAD or FMD who notice symptoms with specific activities should discuss it with their cardiologist.