Rare case of asymptomatic spontaneous coronary artery dissection

We present a case of a 46-year-old woman who presented to the emergency room after a syncopal episode. Most of her initial workup did not lead to any diagnosis. However, the transthoracic echocardiogram showed new onset left ventricular dysfunction. Further, cardiac evaluation showed a chronic coronary artery dissection in the proximal left anterior descending artery. Syncope was related to vasovagal event but rapid plasma reagin being positive led to the question of whether the coronary artery dissection was secondary to vasculitic manifestation of prior syphilis infection. More research is needed to answer this question and to find such an association. Learning objective: Spontaneous coronary artery dissection (SCAD) is a rare disease of young adults that can present acutely as an acute coronary syndrome (ACS) with chest pain, as malignant ventricular arrhythmia, and even as sudden cardiac death. Our report is focused on evaluation and management of SCAD, more importantly to consider SCAD as a differential diagnosis in ACS in young patients, especially females. Our review also stresses the need for further research toward development of consensus on management of such patients.