ST-Segment Elevation Myocardial Infarction (STEMI) Secondary to Spontaneous Coronary Artery Dissection of the Right...

Spontaneous coronary artery dissection (SCAD) is a rare and serious condition that can lead to acute coronary syndrome (ACS). It is characterized by a spontaneous tear in the coronary artery wall that is not related to trauma, medical intervention, or atherosclerotic disease, occurring particularly in young women and those in the peripartum period. Missed diagnoses are driven by a low suspicion of ACS in young women and a lack of clinician familiarity with the condition. Early recognition and appropriate management are key to improving patient outcomes. Recent studies suggest the improved recognition of SCAD due to dedicated SCAD registries and newer imaging techniques such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS). We report a case of a 35-year-old woman who presented with retrosternal chest pain radiating to the left upper limb. Investigations were significant for an elevated troponin I level, while the initial electrocardiogram (ECG) was unremarkable. Coronary angiography revealed spiral dissection involving the right coronary artery, suggesting SCAD type 2. The patient was admitted as a case of SCAD for conservative treatment. During hospitalization, she developed a new episode of chest pain. Her repeated ECG revealed an inferior wall ST-segment elevation myocardial infarction (STEMI). She underwent percutaneous coronary intervention (PCI) with three overlapping drug-eluting stents. Furthermore, this article provides a detailed review of SCAD, including clinical presentation, associated conditions and factors, diagnosis, treatments, and complications based on literature synthesis.