A Case Report on Spontaneous Coronary Artery Dissection and Its Potential Correlation With Fibromuscular Dysplasia

This is a presentation of a common symptom, acute chest pain, with a rare etiology and the relevant implications of spontaneous coronary artery dissection (SCAD) and fibromuscular dysplasia (FMD). In a tertiary hospital in South Florida, during the fall of 2023, an adult female patient with acute chest pain was admitted to the internal medicine ward. The ECG demonstrated no acute ischemic changes. Troponin I levels were initially low upon admission at 0.012 ng/mL, borderline at four hours at 0.087 ng/mL, and increased to 9.49 ng/mL after eight hours. The patient was immediately taken for catheterization due to concerns of a high-risk condition, which revealed two SCADs: a mid-left anterior descending artery type 3 and a midposterior left ventricular artery type 2. Computed tomography angiography of the abdomen and pelvis demonstrated hooked morphology of the celiac trunk, with evidence of increased peak velocity of the celiac artery, typically seen in median arcuate ligament syndrome. However, the patient presented no symptoms such as abdominal pain, nausea, or vomiting. FMD was considered a clinical diagnosis as it explains the SCAD in the absence of other risk factors. In patients with coronary artery dissection and no other risk factors, it is crucial to consider the likelihood of FMD as an underlying cause and to evaluate the patient for different manifestations of FMD.