Spontaneous coronary artery dissection: a rare etiology of ST elevation myocardial infarction

Spontaneous coronary artery dissection (SCAD) is an extremely rare etiology of acute myocardial infarction, most commonly seen in pre-menopausal women with no risk factors for atherosclerotic coronary artery disease (CAD). We present the case of a 41-year-old woman with no history of systemic illness who presented severe, oppressive retrosternal pain with ST-segment elevations in leads I, AVL, V1 through V6 in the absence of risk factors for CAD. Emergency percutaneous coronary intervention (PCI) revealed an aneurysmatic dilatation of the left main coronary artery with complete dissection of the left anterior descending artery and the ramus branch, causing distal occlusion of the affected vessels. The patient was submitted for emergency Coronary Artery Bypass Graft (CABG) surgery. This is thought to be caused by hormonal changes that cause weakness of the vasa vasorum and promote hemorrhage into the media.