Case Report: Spontaneous coronary artery dissection and ventricular fibrillation cardiac arrest –treatment dilemma of whether to place an implantable cardioverter defibrillator

Background: Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome (ACS) predominantly affecting young women, often associated with fibromuscular dysplasia (FMD). Though increasingly recognized, it remains underrepresented in literature. Case summary: We present a case of a young woman with ACS and ventricular arrhythmia leading to cardiac arrest due to SCAD and discuss clinical decision-making regarding secondary prevention ICD placement. This patient was discharged without an ICD. Unfortunately, she was rehospitalized in the setting of persistent vertigo and subsequently diagnosed with fibromuscular dysplasia (FMD) in the setting of a carotid artery dissection. She remained stable and was discharged with close cardiology and neurology follow-up for management of FMD. Discussion: There is no definitive evidence for or against placement of a secondary prevention ICD in patients who present with ventricular arrhythmias in the setting of SCAD due to FMD. This case highlights the complexity of SCAD management, particularly regarding ICD placement for secondary prevention. Further research into long-term outcomes, especially in SCAD cases associated with genetic vasculopathies like FMD, is needed. Conclusion: This case highlights the challenges of ICD decision-making in SCAD with systemic vasculopathy and emphasizes the importance of guideline-directed conservative management.