When Back Pain Is Cardiac: Spontaneous Coronary Artery Dissection in a Male Patient

Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome that is more commonly described in women and is frequently underrecognized in men, particularly when presenting with atypical symptoms. We report the case of a 48-year-old man with a history of hypertension and diabetes who presented with intermittent infrascapular back pain for two weeks without typical anginal features. Initial evaluation revealed markedly elevated cardiac troponin levels, while electrocardiography showed no ischemic changes. Transthoracic echocardiography demonstrated preserved left ventricular systolic function with new regional wall motion abnormalities. Coronary angiography revealed a discrete lesion with diffuse distal narrowing of the first obtuse marginal artery, consistent with a Type 2 spontaneous coronary artery dissection. Given the patient's hemodynamic stability and absence of ongoing ischemia, a conservative management strategy was pursued with antiplatelet therapy and beta-blockade. The patient's symptoms resolved during hospitalization, and he was discharged in stable condition with close outpatient follow-up. This case highlights the diagnostic challenges of SCAD in male patients with atypical presentations and underscores the importance of maintaining a high index of suspicion to ensure timely diagnosis. It also supports conservative medical management as a safe and effective approach in stable patients with SCAD and emphasizes the need for increased awareness and recognition of this condition in populations where it is less commonly reported.