Clinical introduction

A man in his late 50s with a medical history of multiple sclerosis presented with sudden-onset sharp central chest pain, which radiated to the back, jaw and neck. CT aorta ruled out aortic dissection. Blood results showed dynamic troponin-T rise and his ECG showed T-wave inversion in inferolateral leads. He had a coronary angiography. It showed smooth unobstructed right coronary artery and left coronary system was smooth walled except for short stenotic segment in the circumflex artery (moderate-severe) (figure 1A). Spontaneous coronary artery dissection was suspected. He was treated with optimum medical therapy and discharged home.