Spontaneous Coronary Artery Dissection in a Young Female: A Rare Cardiac Catastrophe Without Traditional Risk Factors

Abstract

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome, predominantly affecting young women without traditional cardiovascular risk factors. We report a 32-year-old female who presented with sudden-onset, severe retrosternal chest pain radiating to the left arm, associated with diaphoresis and mild dyspnea. She had no history of hypertension, diabetes, dyslipidemia, smoking, or family history of premature coronary artery disease. Initial evaluation revealed subtle ST-segment changes on electrocardiogram and modestly elevated high-sensitivity troponin I levels. Coronary angiography demonstrated a type 2 SCAD of the mid-left anterior descending artery, confirmed by intracoronary imaging showing an intramural hematoma with preserved distal flow. Laboratory workup, echocardiography, and computed tomography angiography for extracoronary vascular assessment were unremarkable. Given hemodynamic stability and maintained coronary perfusion, the patient was managed conservatively with dual antiplatelet therapy, beta-blockers, and close monitoring, with plans for follow-up imaging to assess vascular healing. This case underscores the importance of considering SCAD in young women presenting with acute chest pain, highlights the critical role of coronary imaging in diagnosis, and demonstrates that tailored conservative management can lead to favorable outcomes while avoiding unnecessary interventions.