Spontaneous Coronary Dissection: An Unusual Etiology of Acute Coronary Syndrome

Spontaneous coronary dissection is a rare condition characterized by a non-traumatic tear in the wall of a coronary artery, with no atherosclerotic or traumatic cause. It mainly affects women and is an infrequent but significant cause of acute coronary syndrome. In this article, a clinical case is presented of a 47-year-old woman with no previous cardiovascular history, presenting with acute chest pain. Investigative findings, including an electrocardiogram, elevated troponin levels and echocardiography, pointed towards an acute coronary syndrome due to coronary dissection. The discussion highlights the rare nature of this condition, mainly seen in women, and points out that it may be associated with pregnancy in a small proportion of cases. Clinical presentation varies from asymptomatic to severe complications such as sudden death. Diagnosis is usually confirmed by coronary angiography, with a specific classification for types of dissection. The article also discusses treatment options, highlighting the lack of consensus on optimal management. Drug treatments are aimed at reducing thrombus formation, while coronary revascularization may be considered in some cases, although this is associated with increased risks of complications. In conclusion, coronary dissection is a rare but significant cause of acute coronary syndrome, especially in young women. Diagnosis relies on coronary imaging, with invasive imaging techniques used in cases of doubt. Management requires an individualized approach, in the absence of a clear consensus on best practice.