Spontaneous coronary artery dissection in a young woman: a case report

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome (ACS), particularly in young women without conventional risk factors. Recognition is essential as management differs from atherosclerotic ACS.

A 27-year-old woman with no cardiovascular history presented to the emergency department with acute left-sided chest pain radiating to the left arm. Initial evaluation showed elevated troponin levels and an electrocardiogram with nonspecific ST-segment changes. Transthoracic echocardiography revealed mildly reduced left ventricular systolic function (≈45%) with apical hypokinesia. She was initially treated with aspirin, while dual antiplatelet therapy was deferred pending definitive diagnosis. Coronary computed tomography angiography demonstrated a short-segment, high-grade stenosis of the proximal left anterior descending (LAD) artery with features suggestive of SCAD. Subsequent invasive coronary angiography confirmed the diagnosis, showing a severe (~90%) LAD stenosis with TIMI 2 flow. Given the lesion severity and impaired coronary flow, percutaneous coronary intervention with drug-eluting stent implantation was performed, successfully restoring TIMI 3 flow.

SCAD often presents with nonspecific ECG findings, and initial troponins may be normal in a substantial proportion of patients, contributing to diagnostic delay. While coronary CT angiography may aid diagnosis in selected cases, invasive angiography remains the gold standard. Management requires careful consideration of lesion characteristics and clinical stability, as conservative treatment is often preferred but not always feasible.

SCAD should be considered in young women presenting with ACS-like symptoms, even in the absence of cardiovascular risk factors. Timely diagnosis and individualized management are essential to optimize outcomes.