not-yet-known not-yet-known not-yet-known unknown 1 Case history/examination A 51-year-old female experienced acute severe chest pain and developed bystander witnessed out-of-hospital cardiac arrest. Basic life support was immediately initiated, and upon arrival of paramedic staff, an ECG showed ventricular fibrillation. Resuscitation was successful, and return of spontaneous circulation was achieved shortly prior to arrival at the cardiac laboratory, where the patient was initially stabilized. An echocardiography showed an ejection fraction of approximately 25% and regional hypokinesia in the supply area of LAD. The following coronary angiography revealed pronounced SCAD with dissection of the left main coronary artery and LAD branch (Figure 1A). The patient was discussed ad-hoc with thoracic surgeons, but deemed unfit for surgery. 1 Case history/examination