Spontaneous multivessel coronary artery dissection in a female without connective tissue disease: An acute myocardial infarction in a young patient

We describe a case of a 38-year-old woman who presented with acute pleuritic chest pain following 3 days of emesis. There was a significant rise in troponin-I, consistent with a non-ST-segment elevation myocardial infarction (NSTEMI). Coronary angiography demonstrated a probable spontaneous coronary artery dissection (SCAD) with intramural haematoma of the left anterior descending (LAD) artery. The procedure was also complicated by an iatrogenic dissection of the right coronary artery (RCA), necessitating emergency stenting. The LAD dissection was managed conservatively. One month later, she represented to hospital with ongoing chest pain and mildly elevated troponin-I. Repeat coronary angiography revealed severe narrowing of the proximal LAD with a dissection flap and intramural dye staining in the proximal left circumflex (LCx) artery. Following multidisciplinary discussions, the patient was managed conservatively with medical management consisting of a beta-blocker, long-acting nitrate and single antiplatelet therapy. She was closely monitored with serial computed tomography coronary angiography (CTCA). Further investigations for underlying connective tissue disorders and fibromuscular dysplasia were unremarkable.