Introduction
Spontaneous coronary artery dissection (SCAD) is an intramural loosening
and bleeding of the tunica media within a coronary artery wall that can
lead to reduced blood flow or complete luminal arterial obstruction. The
clinical presentation varies from short-term chest discomfort to severe
chest pain and acute coronary syndrome with risk of myocardial
infarction [1]. The prevalence of SCAD among all patients
hospitalized with acute coronary syndrome is approximately 4% [2],
while up to 90% of all SCAD cases are seen among younger females aged
43-57 with no prior cardiovascular risk factors [3]. SCAD most
commonly affects the left anterior descending (LAD) coronary artery
[4]. The etiology is multifactorial and known predisposing factors
include underlying vessel- or connective tissue diseases such as
fibromuscular dysplasia, various genetic syndromes such as Marfan-
Ehlers-Danlos, Loeys-Dietz and Alport syndromes, as well as hormonal
fluctuations including pregnancy, hypertension and systemic inflammatory
conditions. In predisposed individuals, SCAD can be triggered and
manifest after physical- or emotional stress [5].