Spontaneous coronary artery dissection is a rare but deadly disease process that continues to have an elusive pathophysiology and treatment strategy. We present a 32 year old patient who suffered from a spontaneous dissection of the left anterior descending artery. Multiple case reviews in the literature were reviewed, but no randomized controlled trials are available to help guide our therapy. A conservative strategy was chosen until her pain recurred and a second-look angiogram was performed. Coronary dissection progressed to the circumflex system and severe ventricular dysfunction was noted. The patient recovered well from coronary artery bypass grafting and was discharged in stable condition. This report reviews the proposed pathophysiology and summarizes the literature in terms of appropriate management of these patients.
Key words: Spontaneous coronary artery, patient, dissection.