Unusual Presentation of Spontaneous Coronary Artery Dissection in an Older Male

Spontaneous coronary artery dissection (SCAD) is a variant of acute coronary syndrome (ACS) that is poorly understood. SCAD has been linked to fibromuscular dysplasia (FMD), connective tissue disease (CTD), pregnancy and hormonal imbalance, systemic inflammatory conditions (e.g. IBD, vasculitis), and coronary artery vasospasm rather than traditional cardiac risk factors. Symptomology generally accompanying SCAD is indistinguishable from ACS making the timely recognition and diagnosis vital for prompt treatment. Management of SCAD is not well defined given the absence of guidelines; conservative therapy with or without invasive intervention is assessed on a case-by-case basis. In this article, we report the case of a 62-year-old male, who presented with chest pain and dyspnea on exertion and was found to have an elevated troponin-I level and corresponding electrocardiogram (EKG) findings, subsequently diagnosed with a non-ST elevation myocardial infarction (NSTEMI). Coronary angiography revealed a distal right coronary artery (RCA) dissection, which was confirmed later with intravascular ultrasound (IVUS). The patient then underwent percutaneous coronary intervention (PCI) followed by stenting of the distal RCA and was discharged on optimal medical therapy. Herein, we report a case of SCAD in an otherwise healthy male with chest pain at rest and with mild exertion without conventional cardiac risk factors.