Spontaneous Coronary Artery Dissection in a 49-Year-Old Woman Following Sexual Activity: A Case Report

Spontaneous coronary artery dissection (SCAD) is a rare but significant cause of acute coronary syndrome (ACS), particularly among middle-aged women. Unlike atherosclerotic ACS, SCAD is characterized by the separation of the coronary artery wall layers, leading to intramural hematoma formation and potential myocardial infarction. While SCAD is often associated with emotional or physical stressors, its pathophysiology remains incompletely understood, with hormonal, genetic, and arteriopathic factors playing significant roles. Here, we present a case of a 49-year-old woman with a history of hypertension, obesity, and prediabetes who developed SCAD following sexual activity. She presented with acute chest pain, ST-segment elevations, and reduced left ventricular ejection fraction (LVEF). Coronary angiography confirmed a type 2 SCAD involving the left anterior descending artery, left main, and left circumflex arteries. Conservative management with temporary mechanical circulatory support was pursued due to reduced LVEF. This case underscores the importance of recognizing SCAD in atypical presentations and highlights the role of conservative management strategies to optimize patient outcomes.