Idiopathic Spontaneous Coronary Artery Dissection: A Rare Cause of Acute Myocardial Infarction Successfully Treated With Conservative Management

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome (ACS) characterized by separation of the coronary arterial wall layers, leading to impaired coronary blood flow. It predominantly affects women and has been associated with triggers such as emotional stress and intense physical exertion. We report the case of a 44-year-old woman with no prior cardiovascular history who presented with acute chest pain and elevated troponin levels. Her initial electrocardiogram (ECG) was unremarkable, raising suspicion for non-ST-elevation myocardial infarction (NSTEMI). Subsequent coronary angiography revealed a spontaneous dissection of the first obtuse marginal artery (OM1). During hospitalization, the patient developed atrial fibrillation but remained hemodynamically stable and was managed conservatively. At one-year follow-up, she remained asymptomatic without recurrent angina or arrhythmias. This case highlights the importance of considering SCAD in younger patients, particularly women without traditional cardiovascular risk factors, presenting with symptoms of ACS, even when the initial ECG is non-diagnostic. Early recognition is essential to avoid delays in diagnosis and optimize management.