Key result
SCAD with cardiogenic shock unmasks coexisting saw-tooth cardiomyopathy in a young patient.
Why the study?
The coexistence of spontaneous coronary artery dissection (SCAD) with saw-tooth cardiomyopathy has not previously been reported, representing a gap in clinical knowledge.
Case Report (n=1)
This first reported case of coexisting spontaneous coronary artery dissection and saw-tooth cardiomyopathy highlights the essential role of multimodality imaging in distinguishing acute ischemic injury from underlying structural cardiomyopathy.
Multimodality imaging aids SCAD diagnosis with concurrent saw-tooth cardiomyopathy in young adults; leaves open whether this association is causal or requires prospective confirmation.
BACKGROUND: Saw-tooth cardiomyopathy is an exceptionally rare form of left ventricular dysplasia characterized by distinctive myocardial serrations. Although associated with heart failure, arrhythmias, thromboembolic events, and mitral valve prolapse, its coexistence with spontaneous coronary artery dissection (SCAD) has not previously been reported. CASE SUMMARY: A 25-year-old man presented with severe ischemic chest pain, ST-segment elevation, and Society for Cardiovascular Angiography & Interventions Stage C cardiogenic shock with acute pulmonary edema. Coronary angiography demonstrated spontaneous coronary artery dissection, while cardiac magnetic resonance confirmed extensive ischemic myocardial injury and characteristic features of saw-tooth cardiomyopathy. He was managed conservatively with guideline-directed medical therapy. Follow-up imaging demonstrated persistent severe left ventricular systolic dysfunction despite negative extended genetic testing. DISCUSSION: Multimodality imaging distinguished acute SCAD-related myocardial infarction from a preexisting structural cardiomyopathy. TAKE-HOME MESSAGES: Acute SCAD may unmask previously unrecognized structural myocardial abnormalities. Multimodality imaging is essential for distinguishing acute ischemic myocardial injury from underlying cardiomyopathy and guiding management. Saw-tooth cardiomyopathy remains an exceptionally rare myocardial phenotype with an uncertain genetic basis and long-term prognosis, warranting genetic evaluation and longitudinal follow-up when clinically indicated.
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Young et al. (2026) conducted a case report in Spontaneous coronary artery dissection and saw-tooth cardiomyopathy (n=1). Spontaneous coronary artery dissection and saw-tooth cardiomyopathy was evaluated. A 25-year-old man with spontaneous coronary artery dissection and cardiogenic shock was diagnosed with coexisting saw-tooth cardiomyopathy, demonstrating that SCAD can unmask structural abnormalities.
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