Spontaneous Coronary Artery Dissection in a Female Patient With Acute Myocardial Infarction

Spontaneous coronary artery dissection (SCAD) is the formation of a false lumen within a vessel wall, with an accumulation of blood leading to vessel occlusion, mimicking symptoms of acute myocardial infarction (AMI). Here, we discuss the case of a middle-aged woman with STEMI who was found to have coronary artery dissection on coronary angiography during left heart catheterization. Clinicians should have a high suspicion of SCAD in young females presenting with AMI without traditional risk factors for coronary artery disease. Such patients should receive urgent angiography. Once the diagnosis is confirmed, there are no clear guidelines for treating AMI secondary to SCAD. Hemodynamically stable patients can be managed with the immediate initiation of antiplatelet therapy and beta-blockers. Thrombolytic therapy is avoided due to the risk of dissection and intramural hematoma. Coronary artery bypass graft (CABG) is indicated in patients with multiple vessel involvement or patients who have had a primary coronary intervention fail. Bioresorbable vascular scaffolds (BVS) may be a better option in STEMI or hemodynamic instability. However, current treatment strategies are based on expert opinion and a few case studies.