Beyond the Norm: Decoding Spontaneous Coronary Artery Dissection as an Unusual Cause of Acute Coronary Syndrome.

Abstract

Description Spontaneous coronary artery dissection (SCAD) is a rare nonatherosclerotic cause of myocardial infarction among young women, particularly during pregnancy. As the name suggests, SCAD is caused by the spontaneous formation of the false lumen within the coronary artery wall, thus compromising the blood flow to the myocardium. Unlike atherosclerotic acute coronary syndromes, SCAD is not directly associated with diabetes or hypertension; moreover, underlying connective tissue defects and inflammation are considered more contributory towards its etiology. Although its pathophysiology is not well understood, multiple theories have been proposed. Clinically, SCAD has a similar presentation to acute coronary syndromes, including substernal chest pain, elevated cardiac enzymes, ST-segment elevation myocardial infarction, and T wave changes on the ECG. Due to its elusive etiology, variable clinical presentation, and potential for catastrophic outcomes, it is essential to make a proper diagnosis using tools such as coronary angiography, optical coherence tomographic imaging, intravascular ultrasound, and cardiac magnetic resonance imaging. In this article, we review the current understanding of SCAD, encompassing its epidemiology, pathophysiology, clinical presentation, and diagnostic and management options.