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].