A large spontaneous coronary artery dissection in the bifurcation causing an acute myocardial infarction in a young male: a case report and mini literature review

Spontaneous coronary artery dissection (SCAD) at the bifurcation is a rare cause of acute myocardial infarction (AMI). The pathophysiology of SCAD is poorly understood with its diagnosis and management remaining challenging. Here we describe a case of a 22 year old man presenting with acute antero-lateral ST segment depression and raised levels of plasma troponin and creatine kinase caused by a large spontaneous dissection in the bifurcation of the left main coronary artery, left anterior descending artery and circumflex artery (CX) with the initial part of CX occluded by the dissecting aneurysm. The patient underwent urgent coronary artery bypass grafting (CABG) with great effect. Follow up coronary angiography at 5 months post the insult revealed decreased coronary artery ectasia along with recovery of CX blood flow. Since SCAD commonly occurs in otherwise healthy individuals, angiography serves as a critical tool in early diagnosis and management of this life-threatening condition.