We present a case of a 66-year-old lady with chest pain, without dynamic
12-lead electrocardiographic (ECG) changes and normal serial
troponin. Coronary angiography revealed a linear filing defect in
the first obtuse marginal branch of the circumflex artery indicating
coronary artery dissection, with superadded thrombus. She was managed
medically with dual antiplatelet therapy and has responded well.
Spontaneous coronary artery dissection (SCAD) is a rare cause of cardiac
chest pain, which can be missed without coronary angiography.
Unlike most other lesions in patients with unstable symptoms, where
coronary intervention with stenting is recommended, patients with
SCAD generally fare better with conservative measures than with intervention,
unless there is hemodynamic instability.