Spontaneous Coronary-Artery Dissection

A 43-year-old woman with a history of migraine headaches presented to the emergency department with acute onset, crushing retrosternal chest pain that radiated to her back and left arm, accompanied by dyspnea and nausea, which began suddenly after she coughed vigorously. Her symptoms were not relieved by nitroglycerin. Initial vital signs were normal, but an electrocardiogram showed ST-segment elevations in the inferior and lateral leads. Laboratory tests revealed an elevated troponin I level of 4.5 ng per milliliter. Emergent coronary angiography was performed, revealing a spiral dissection of the mid-right coronary artery with thrombolysis in myocardial infarction (TIMI) grade 3 flow. A drug-eluting stent was placed, leading to resolution of the ST-segment elevations and symptoms. Six weeks later, repeat angiography showed resolution of the dissection and patency of the stent. The patient was diagnosed with spontaneous coronary-artery dissection (SCAD), a non-atherosclerotic cause of acute coronary syndrome predominantly affecting women, often associated with fibromuscular dysplasia (FMD). The patient's presentation followed a Valsalva-like maneuver (vigorous cough), which is a common trigger. Genetic testing for FMD was offered but declined. The patient continued to do well at a 1-year follow-up

A 43-year-old woman with a history of migraine headaches presented to the emergency department with acute onset, crushing retrosternal chest pain that radiated to her back and left arm, accompanied by dyspnea and nausea, which began suddenly after she coughed vigorously. Her symptoms were not relieved by nitroglycerin. Initial vital signs were normal, but an electrocardiogram showed ST-segment elevations in the inferior and lateral leads. Laboratory tests revealed an elevated troponin I level of 4.5 ng per milliliter. Emergent coronary angiography was performed, revealing a spiral dissection of the mid-right coronary artery with thrombolysis in myocardial infarction (TIMI) grade 3 flow. A drug-eluting stent was placed, leading to resolution of the ST-segment elevations and symptoms. Six weeks later, repeat angiography showed resolution of the dissection and patency of the stent. The patient was diagnosed with spontaneous coronary-artery dissection (SCAD), a non-atherosclerotic cause of acute coronary syndrome predominantly affecting women, often associated with fibromuscular dysplasia (FMD). The patient's presentation followed a Valsalva-like maneuver (vigorous cough), which is a common trigger. Genetic testing for FMD was offered but declined. The patient continued to do well at a 1-year follow-up