Spontaneous Coronary Artery Dissection: A Challenging Diagnosis

Spontaneous coronary artery dissection (SCAD) is a relatively uncommon cause of acute coronary syndrome, which is mainly reported in postpartum patients and patients without typical cardiac risk factors. Our case was a 58-year-old female with a history of diabetes, hypertension, and hyperlipidemia who presented with non-exertional crushing retrosternal chest pain and was found to have ST elevation in inferior leads. Immediate cardiac catheterization was suggestive of spontaneous dissection of the third obtuse marginal artery, which was managed conservatively. Clinical suspicion is crucial for SCAD diagnosis, as it might be difficult to distinguish between coronary artery occlusion and SCAD. Moreover, revascularization in SCAD can be associated with complications. Therefore, SCAD needs to be considered as a differential diagnosis not only in patients without cardiac risk factors but also in patients with known cardiac risk factors like our case.