Emotion-triggered spontaneous coronary artery dissection in a patient with multiple cardiovascular risk factors: navigating the diagnostic overlap with atherosclerotic acute coronary syndrome and Takotsubo cardiomyopathy

Spontaneous coronary artery dissection (SCAD), once considered rare, is increasingly recognized as a cause of acute coronary syndrome (ACS) owing to advances in coronary imaging. Although classically described in women with no or minimal cardiovascular risk factors, differentiation from atherosclerotic myocardial infarction remains challenging when multiple risk factors are present. Accurate diagnosis by coronary angiography is essential, because interventions such as percutaneous coronary intervention and thrombolysis may cause harm in SCAD. Diagnostic overlap with Takotsubo cardiomyopathy (TTC; also called stress cardiomyopathy) further complicates early evaluation. Important gaps remain regarding who is at risk, the triggers involved, and the association with fibromuscular dysplasia (FMD). We report a 51-year-old woman with multiple cardiovascular risk factors who developed SCAD two days after an acute emotional stressor, with negative FMD screening.