A Case of Type 4 Spontaneous Coronary Artery Dissection (SCAD)

A 52-year-old female presented to the emergency department ten minutes after the development of sudden-onset crushing chest pain radiating to both of her arms, associated with dyspnea on exertion. Notably, she reported a several-month history of significant stress caring for her elderly mother with Alzheimer’s disease. On admission, her vital signs revealed sinus bradycardia with a heart rate of 56 beats/min. The patient reported a past medical history of hypothyroidism, breast cancer status post lumpectomy, nicotine dependence, and anxiety. She did not have a prior history of cardiovascular disease or stroke, nor a family history of premature coronary disease. She also had no prior radiation or chemotherapy. Her medications included levothyroxine and propranolol as needed for panic attacks.