Spontaneous Coronary Artery Dissection in a Young Women: A Case Report and Literature Review

Spontaneous coronary artery dissection (SCAD) is an infrequent etiology of acute coronary syndrome, characterized by its non-atherosclerotic, non-traumatic, and non-iatrogenic nature. SCAD involving the left main coronary artery (LMCA) constitutes an especially severe manifestation of this condition. This report details a complex and critical case of LMCA SCAD in a 38-year-old female patient who presented with chest pain, syncope, cardiogenic shock, severe hypokalemia, and electrocardiographic changes consistent with De Winter syndrome. Initial urgent coronary angiography (CAG) revealed LMCA stenosis of 40%-50%. Subsequent CAG, supplemented by intravascular ultrasound, demonstrated a progression of LMCA stenosis to 70%-80% and the presence of a diffuse intramural hematoma within the LMCA. Patients with LMCA SCAD are at a heightened risk for short-term complications. Therefore, prompt recognition and the implementation of appropriate management strategies are crucial.