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Although several risk factors are associated with spontaneous coronary artery dissection, strenuous activity is an uncommon risk factor for women. We report a case of a patient who developed spontaneous coronary artery dissection shortly after starting F45, a highly strenuous fitness program. As high-intensity exercise regimens become more mainstream, clinicians should more readily consider spontaneous coronary artery dissection in young patients with history of recent strenuous activity when presenting with symptoms concerning for acute coronary syndrome.

Patients with hepatic hemangiomas have been known to have high-output heart failure as a result of left-to-right arteriovenous shunting. We report a patient with a hepatic hemangioma that presented with high-output heart failure with hypoxia on exertion. After embolization of the hemangioma, the patient's hypoxia resolved and ejection fraction improved. In the absence of cardiopulmonary pathophysiology, we presume that our patient's hemangioma was causing a right-to-left shunt as opposed to an expected left-to-right shunt.