Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome, primarily affecting young, predominantly female individuals without underlying coronary artery disease.

In this case, we discuss its pathogenesis, triggering factors, and therapeutic indications.

A 30-year-old sedentary woman with a BMI of 41kg/m2, a history of hypothyroidism, and pre-eclampsia 18 months ago, presented with worsening chest pain radiating to the left upper limb, neglected for one month. Cardiovascular examination was unremarkable.

Electrocardiogram showed sinus rhythm with sequela Q waves and negative T waves in multiple territories. Blood tests revealed elevated troponins, while cardiac imaging revealed a dilated aneurysmal right ventricle with thrombi (Fig. 1) and hypokinesia of the left ventricle. Coronary angiography confirmed SCAD.

The patient was managed conservatively with aspirin, bisoprolol, atorvastatin, and anticoagulation, resulting in thrombus resolution, improved ejection fraction, and normal coronary flow on follow-up. Screening for other arterial involvement was negative.

In summary, prompt recognition and conservative management of spontaneous coronary artery dissection (SCAD) resulted in favorable outcomes in this young patient, highlighting the importance of early intervention and long-term follow-up in similar cases.