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A 50-year-old hypertensive female presented to us with her first episode of anginal sounding chest discomfort at rest. Her 12-lead ECG demonstrated sinus rhythm with evolving antero-lateral T-wave inversion. Twelve-h Troponin-I was raised at 11.14 ng/ml (normal range 0–0.08 ng/ml).
Coronary angiography revealed two-vessel spontaneous coronary artery dissection (SCAD) involving the right coronary artery extending into the postero-lateral artery (figure 1), and the proximal segment of the first diagonal of the left anterior descending artery (figure 2).