American Research Journal of Clinical Case Reports

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). The true incidence of SCAD is underestimated. The pathophysiology is still not fully understood and its management can be challenging.Patients may present with a broad spectrum of clinical scenarios, ranging from angina pectoris to myocardial infarction, cardiogenic shock, and sudden death. Standard therapy has not been established; current treatments range from conservative management to percutaneous revascularization or coronary artery bypass surgery. SCAD greatly mimics ACS, and this diagnosis should be considered when evaluating young patients who present with ACS with or without classical risk factors for coronary artery disease. We report a case of a 39-year old man who presented with diabetic ketoacidosis (DKA) and presentation of ACS. He had multiple risk factors for CAD such as a smoking history of two pack-years, hypertension and poorly controlled diabetes mellitus type I. Once the clinical findings were suggestive of acute anterior and inferior myocardial infarction, the patient underwent emergent cardiac catheterization, which revealed distal left anterior descending coronary artery dissection. Conclusion: This case highlights the fact that although SCAD is a rare entity, it is increasingly being recognized as a significant cause of ACS. Urgent angiography should be considered if SCAD is suspected, because early diagnosis and appropriate management significantly improves the outcome.