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Unmasking Spontaneous Coronary Artery Dissection in a Patient With Misleading Symptoms and Initial Imaging Results

Judith Gronwald1, Johannes T Kowallick2, Andreas Schuster3

  • 1Department of Cardiology and Pneumology, University Medical Center of Göttingen, Georg-August University, Göttingen, Germany.

JACC. Case Reports
|May 30, 2025
PubMed

Insights

Spontaneous coronary artery dissection (SCAD) can be missed in acute coronary syndrome. Multimodal imaging, including cardiovascular magnetic resonance imaging, aids accurate diagnosis and guides treatment.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS).
  • Conventional and invasive diagnostic methods may fail to detect SCAD, leading to missed or delayed diagnoses.

Observation:

  • A 32-year-old male presented with chest pain and elevated troponin levels, initially suspected of having coronary artery spasm or Takotsubo syndrome.
  • Initial invasive coronary angiography revealed no obstructive coronary artery disease.
  • Cardiovascular magnetic resonance imaging (CMR) demonstrated ischemic myocardial injury, prompting further investigation.

Findings:

  • Second-look invasive coronary angiography with optical coherence tomography (OCT) confirmed spontaneous coronary artery dissection (SCAD) of the left anterior descending artery.
  • The dissection involved an intramural hematoma but preserved TIMI flow grade 3.
  • Conservative medical management was initiated.

Implications:

  • Multimodal imaging, particularly CMR, is crucial for identifying SCAD and other causes of myocardial infarction with nonobstructive coronary arteries (MINOCA).
  • Advanced intravascular imaging like OCT can provide definitive diagnosis when conventional methods are inconclusive.
  • Accurate diagnosis of SCAD enables appropriate conservative management, avoiding unnecessary interventions.
Abstract

Keywords:
acute coronary syndromecardiac magnetic resonancemyocardial infarction

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