A Non-atherosclerotic Heart Tears Apart: A Case of Spontaneous Coronary Artery Dissection in a Healthy Postmenopausal Woman

Case Reports

. 2022 May 29;14(5):e25459.

doi: 10.7759/cureus.25459.

eCollection 2022 May.


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Case Reports

Vishal Phogat et al.




Due to limited understanding and knowledge of spontaneous coronary artery dissection (SCAD), it is typically believed to affect young peripartum women. We present a case of a post-menopausal older woman who suffered an acute non-ST segment elevation myocardial infarction (NSTEMI), secondary to a SCAD of the right posterior descending artery (PDA), after strenuous exercise. As the patient was hemodynamically stable and without signs of ongoing ischemia, she was managed conservatively. SCAD should be in differentials for patients presenting with acute coronary syndrome (ACS) who have no or few cardiovascular atherosclerotic risk factors. SCAD can be missed due to low suspicion of ACS in young and healthy patients. ACS from SCAD is often misdiagnosed and/or mismanaged as atherosclerotic ACS. Increasing awareness about this condition can lead to earlier diagnosis and prevention of sudden cardiac deaths. As most cases of SCAD can be managed conservatively, differentiating it from atherosclerotic ACS can reduce unnecessary reperfusion procedures and complications thereof.


cardiac death; nste-acs; post partum acs; scad management; scad types; spontaneous coronary dissection; sudden cardiac.

Conflict of interest statement

The authors have declared that no competing interests exist.


Figure 1. Electrocardiogram showing a normal sinus rhythm

Normal sinus rhythm with a ventricular rate of 66 beats per minute was seen on an electrocardiogram. No acute ST segment or T wave changes were noticed.

Figure 2

Figure 2. Coronary angiogram LAO view showing a right posterior descending artery spontaneous coronary artery dissection

Right coronary angiogram LAO view shows smooth and diffuse stenosis and string-like appearance of the right posterior descending artery (pointed with two arrows), suggestive of type 2 spontaneous coronary artery dissection. LAO – left anterior oblique


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