A 38-year-old woman without traditional coronary risk factors presents with acute anterior STEMI. Coronary angiography shows no atherosclerotic disease but a spiral filling defect suggesting an intimal flap in the left anterior descending artery. Which of the following is the most likely underlying etiology?

• A Coronary artery embolism from infective endocarditis
• B Coronary vasospasm (Prinzmetal angina)
• C Spontaneous coronary artery dissection (SCAD) ✓
• D Thrombosis due to antiphospholipid syndrome

Explanation

Spontaneous coronary artery dissection (SCAD) is an important cause of MI in young women without traditional risk factors. It results from formation of an intramural hematoma creating an intimal flap, compressing the true lumen. SCAD is associated with fibromuscular dysplasia and peripartum state. Coronary embolism, vasospasm, and APS do not produce an intimal flap.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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