This case highlights that spontaneous coronary artery dissection (SCAD) can present without ECG changes or troponin elevation and is generally best managed conservatively with medical therapy.
SCAD merits consideration in troponin-negative chest pain; leaves open optimal management pending prospective data.
We present a case of a 66-year-old lady with chest pain, without dynamic 12-lead electrocardiographic (ECG) changes and normal serial troponin. Coronary angiography revealed a linear filing defect in the first obtuse marginal branch of the circumflex artery indicating coronary artery dissection, with superadded thrombus. She was managed medically with dual antiplatelet therapy and has responded well. Spontaneous coronary artery dissection (SCAD) is a rare cause of cardiac chest pain, which can be missed without coronary angiography. Unlike most other lesions in patients with unstable symptoms, where coronary intervention with stenting is recommended, patients with SCAD generally fare better with conservative measures than with intervention, unless there is hemodynamic instability.
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Spinthakis et al. (2016) studied this question.
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