Recurrent Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome (ACS) and sudden cardiac death. It has been associated with several predisposing factors, including hormone replacement therapy, autoimmune disorders, fibromuscular dysplasia (FMD), connective tissue diseases, atherosclerosis, migraine, pregnancy, and the postpartum period. SCAD most commonly affects young to middle-aged women who present with acute myocardial infarction (MI) despite the absence of traditional atherosclerotic risk factors. Coronary angiography remains the gold standard for diagnosis, allowing visualization of the characteristic dissection patterns within the coronary vessel wall. Management is typically conservative as spontaneous healing of the dissection is common; however, revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) may be necessary in patients with hemodynamic instability, ongoing ischemia, or failure of medical therapy.