Alfaraj Dunya, Alnimer Razan, Ahmed Bayan, Abdali Fatima, Ali Tahera, Alsharidah Mohammad
Department of Emergency, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam, SAU.
College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU.
Cureus. 2025 Aug 11;17(8):e89792. doi: 10.7759/cureus.89792. eCollection 2025 Aug.
Spontaneous coronary artery dissection (SCAD) is a rare and serious condition that can lead to acute coronary syndrome (ACS). It is characterized by a spontaneous tear in the coronary artery wall that is not related to trauma, medical intervention, or atherosclerotic disease, occurring particularly in young women and those in the peripartum period. Missed diagnoses are driven by a low suspicion of ACS in young women and a lack of clinician familiarity with the condition. Early recognition and appropriate management are key to improving patient outcomes. Recent studies suggest the improved recognition of SCAD due to dedicated SCAD registries and newer imaging techniques such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS). We report a case of a 35-year-old woman who presented with retrosternal chest pain radiating to the left upper limb. Investigations were significant for an elevated troponin I level, while the initial electrocardiogram (ECG) was unremarkable. Coronary angiography revealed spiral dissection involving the right coronary artery, suggesting SCAD type 2. The patient was admitted as a case of SCAD for conservative treatment. During hospitalization, she developed a new episode of chest pain. Her repeated ECG revealed an inferior wall ST-segment elevation myocardial infarction (STEMI). She underwent percutaneous coronary intervention (PCI) with three overlapping drug-eluting stents. Furthermore, this article provides a detailed review of SCAD, including clinical presentation, associated conditions and factors, diagnosis, treatments, and complications based on literature synthesis.
自发性冠状动脉夹层（SCAD）是一种罕见且严重的病症，可导致急性冠状动脉综合征（ACS）。其特征是冠状动脉壁出现自发性撕裂，与创伤、医疗干预或动脉粥样硬化疾病无关，尤其发生在年轻女性和围产期女性中。漏诊是由于对年轻女性ACS的怀疑度低以及临床医生对该病症缺乏了解。早期识别和适当管理是改善患者预后的关键。近期研究表明，由于专门的SCAD登记系统以及诸如光学相干断层扫描（OCT）和血管内超声（IVUS）等更新的成像技术，对SCAD的识别有所改善。我们报告一例35岁女性患者，她出现胸骨后胸痛并向左上肢放射。检查发现肌钙蛋白I水平升高，而初始心电图（ECG）无明显异常。冠状动脉造影显示右冠状动脉螺旋状夹层，提示2型SCAD。该患者以SCAD病例入院接受保守治疗。住院期间，她出现了新的胸痛发作。她反复的心电图显示下壁ST段抬高型心肌梗死（STEMI）。她接受了经皮冠状动脉介入治疗（PCI），植入了三个重叠的药物洗脱支架。此外，本文基于文献综述对SCAD进行了详细回顾，包括临床表现、相关病症和因素、诊断、治疗及并发症。
