A rare case of spontaneous coronary artery dissection causing acute coronary syndrome

Abstract Spontaneous coronary artery dissection (SCAD) is an uncommon pathological entity and a recognized cause of acute coronary syndrome (ACS). We report the case of a 64-year-old hypertensive woman who presented with severe chest pain and was diagnosed with ST-elevation myocardial infarction. Prior to this event, she had been receiving maximum-dose cabergoline therapy following surgical resection of a pituitary macroadenoma. Emergency coronary angiography demonstrated complete occlusion of the left anterior descending artery. Following successful revascularization of the culprit vessel, a diffuse stenosis of the distal segment was identified, consistent with SCAD, and subsequently treated with balloon dilatation. Cabergoline therapy was discontinued, and the patient was managed with a comprehensive antithrombotic regimen. At follow-up, a mild apical wall motion abnormality persisted, although she remained asymptomatic. A notable aspect of this case was the suspected association between cabergoline-induced vasospasm and SCAD. Cabergoline, an ergot-derived dopamine agonist, is well recognized for its vasospastic potential.