A Noninvasive Diagnostic Approach for Identifying Spontaneous Coronary Artery Dissection (SCAD) in Young Women: A Case Report and Review of the Literature.

A 19-year-old female patient presented with an acute onset of substernal chest pain, accompanied by dyspnea and diaphoresis while walking to the gym. She was able to start her routine, but the pain worsened. She was taken to the emergency room, where an electrocardiogram was performed, and no irregularities were observed, while the troponin test was significantly elevated. Imaging studies, including a Doppler echocardiogram and an emergent CT of the chest to rule out aortic dissection, returned normal results. The pain subsided after two hours, but troponin kept increasing; consequently, spontaneous coronary artery dissection (SCAD) was suspected. In view of the young age of the patient, it was decided to refrain from performing a coronary angiogram, intravascular ultrasound, or optical coherence tomography. A CT coronary angiography scan did not show any anomaly. A cardiac magnetic resonance imaging showed a clear subendocardial enhancement indicative of a myocardial infarction. A diagnosis of SCAD was confirmed, and no further testing was done. The patient was started on aspirin and beta-blockers, and advised to perform only minimal to moderate exercise and to consult a healthcare physician immediately if the episode recurs. CT angiogram ruled out fibrodysplasia of the renal arteries, and plasma metanephrines were normal. This case shows that with the advancement of noninvasive techniques, there is probably no need for invasive measures to diagnose SCAD in stable patients.