Idiopathic Spontaneous Coronary Artery Dissection: A Rare Cause of Acute Myocardial Infarction Successfully Treated With Conservative Management

Figures

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  Figure 1. Electrocardiogram on admission Sinus rhythm with findings consistent with lateral subendocardial ischemia, including ST-segment depression in leads V4-V6, I, and aVL.

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  Figure 2. Coronary angiography on admission Angiographic image showing a SCAD involving the mid-to-distal segment of the OM1, characterized by a long segment of smooth, diffuse narrowing consistent with SCAD type 2b (red arrows). A change in vessel caliber is also observed (green arrows). SCAD, spontaneous coronary artery dissection; OM1, first obtuse marginal artery

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  Figure 3. Transthoracic echocardiography findings (A) Apical two-chamber view with endocardial tracing of the left ventricle for volumetric assessment using Simpson’s method. (B) Apical view demonstrating measurement of left ventricular diameter. (C) View showing measurement of the LVOT and aortic root. (D) Apical four-chamber view demonstrating left atrial planimetry. LVOT, left ventricular outflow tract

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  Figure 4. Computed tomography angiography of the thoracic, abdominal, and pelvic vasculature performed to evaluate for associated arteriopathies (A) Thoracic view demonstrating a normal thoracic aorta without aneurysm or dissection. (B) Abdominal view showing normal renal arteries without stenosis or "string-of-beads" appearance suggestive of fibromuscular dysplasia. (C) Pelvic view demonstrating normal iliac arteries. No vascular abnormalities were identified.

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  Figure 5. Clinical timeline of the patient’s presentation and follow-up NSTEMI, non-ST-segment elevation myocardial infarction; SCAD, spontaneous coronary artery dissection; OM1, first obtuse marginal artery; ACE, angiotensin-converting enzyme; AF, atrial fibrillation Created by Canva Pro (Canva, Sydney, Australia)