Slit in the Coronaries: A Case of Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is a noniatrogenic epicardial coronary artery dissection unrelated to an atherosclerotic disease process. SCAD is responsible for a small percentage of acute coronary syndrome (ACS) cases. The left anterior descending (LAD) artery is the most common artery affected in SCAD, although any coronary artery can be affected. We present an interesting case of SCAD presenting as an ST-elevation myocardial infarction complicated with dissection extending to the left main and distal LAD requiring emergent coronary artery bypass grafting. Our case emphasizes the importance of considering SCAD as a cause for ACS, especially in young patients with minimal atherosclerotic risk factors. Also, a very high recurrence rate demands strict follow-up and multidisciplinary decision making in the population impacted with this rare entity.