When Cardiac Magnetic Resonance Changed the Diagnosis of a Young Patient With Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection (SCAD) is a significant cause of acute coronary syndrome, myocardial infarction, arrhythmia, and sudden death, particularly in young women and individuals with few conventional atherosclerotic risk factors, necessitating a high degree of suspicion. The most common risk factors for SCAD include atherosclerosis, females in the peripartum period, autoimmune inflammatory diseases, and connective tissue diseases. We present an unusual case of a young man who was initially suspected of having myocarditis, but cardiac magnetic resonance (CMR) revealed an ischemic pattern in late gadolinium enhancement. A coronary angiography (CA) led to the diagnosis of SCAD. We report a case of a 28-year-old male who presented with typical chest pain on and off for the past three months. Since the patient had no medical or cardiac history, the previous computed tomography CA (CTCA) revealed normal coronaries, raising the suspicion of myocarditis. Consequently, we performed a CMR, which revealed subendocardial delayed enhancement in the apical anterior and mid-anteroseptal segments, thereby ruling out myocarditis. The decision was made here to perform a coronary angiogram, which led to the diagnosis of SCAD.