Spontaneous Coronary Artery Dissection Beyond the Typical Demographic - Multivessel Involvement in a Male Patient

Sep 29, 2026

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Spontaneous coronary artery dissection (SCAD) causes acute myocardial infarction and is uncommon, with typical demographic patterns favoring younger women and few conventional atherosclerotic risk factors. The case describes a 43-year-old man with hypertension and obesity presenting with NSTEMI. Initial coronary angiography suggested distal LAD tapering compatible with SCAD, despite an atypical presentation for men. Cardiac MRI supported a multivessel infarction pattern, and repeat angiography later confirmed healing SCAD in both LAD and right coronary artery, highlighting diagnostic uncertainty and the need for timely recognition.

LanguageEnglish

CategoryHealthcare

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Pages6

Reading Time15 min

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Abstract

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Review began 11/17/2025 Review ended 12/01/2025 Published 12/06/2025 © Copyright 2025 Sheikh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98558 Open Access Case Report Spontaneous Coronary Artery Dissection Beyond the Typical Demographic: Multivessel Involvement in a Male Patient Kiran Sheikh 1, Ali Hameed 2 1. Cardiology, William Harvey Hospital, Kent, GBR 2. Cardiology, Mayo Hospital, Lahore, PAK Corresponding author: Kiran Sheikh, [drkiraniftikhar15@gmail.com](drkiraniftikhar15@gmail.com) Abstract Spontaneous coronary artery dissection (SCAD) is an uncommon but increasingly recognized cause of acute myocardial infarction, predominantly affecting younger women without traditional atherosclerotic risk factors. The underlying pathophysiology remains incompletely understood and is thought to involve a complex interplay between arterial wall vulnerability and precipitating stressors. Moreover, challenges persist in achieving timely diagnosis and defining optimal management strategies. Occurrence of SCAD in men is particularly rare, often leading to diagnostic uncertainty and potential delays in appropriate management. We report the case of a 43-year-old man with a history of hypertension and obesity who presented with anon-ST-elevation myocardial infarction (NSTEMI) . Given his risk profile, an atherosclerotic aetiology was initially presumed. However, coronary angiography demonstrated distal left anterior descending (LAD) artery tapering with an appearance that was thought to be consistent with SCAD. Owing to his atypical demographic for SCAD, this angiographic impression generated a diagnostic dilemma, prompting further evaluation with cardiac magnetic resonance imaging (CMR), which revealed a multivessel infarction pattern. An interval repeat angiogram later demonstrated evolving features of healing SCAD in both the LAD artery and right coronary artery, confirming the diagnosis of multivessel SCAD. Although intracoronary imaging would have been ideal to enhance diagnostic clarity, it was not performed due to the distal location of the suspected SCAD lesions and variable operator experience with intracoronary imaging. This case underscores the importance of considering SCAD even in atypical demographics such as male patients, where preconceived diagnostic assumptions may delay recognition. Greater awareness of its variable angiographic appearance and clinical patterns can help reduce diagnostic uncertainty and improve timely management. Categories: Cardiology Keywords: male patient, multivessel scad, non-atherosclerotic myocardial infarction, scad in men, spontaneous coronary artery dissection Introduction Spontaneous coronary artery dissection (SCAD) predominantly affects younger or middle-aged women, accounting for 87-95% of cases in most series [1] . This striking female predominance has been partly attributed to hormonal influences increasing vascular vulnerability, supported by its higher incidence during pregnancy and the postpartum period ; the exact mechanisms behind this female predominance remain unclear. Conversely, men represent only around 10% of SCAD cases [1] . They tend to present at a younger age and are more often associated with physical stressors rather than the emotional triggers typically described in women. Importantly, there appears to be no significant difference in clinical outcomes between the genders. However, a reversed gender bias exists-even when angiographic or clinical features are suggestive, SCAD is often under-recognized in men, potentially delaying diagnosis and management [1] . Early recognition is therefore essential, as misdiagnosis may lead to inappropriate interventions and worse outcomes. Case Presentation A 43-year-ol

FAQs

What is spontaneous coronary artery dissection (SCAD) and why is it often missed?

SCAD is an uncommon cause of acute myocardial infarction. It is frequently under-recognized in men because typical teaching emphasizes younger women, which can delay diagnosis and appropriate management.

What diagnostic steps were used in this male SCAD case?

After NSTEMI presentation, coronary angiography suggested features consistent with SCAD in the distal LAD. Cardiac magnetic resonance imaging demonstrated a multivessel infarction pattern, and interval repeat angiography later confirmed evolving healing SCAD in both LAD and the right coronary artery.

Why wasn’t intracoronary imaging performed in this report?

Intracoronary imaging was not performed due to the distal location of the suspected lesions and variable operator experience with intracoronary imaging.

Sep 29, 2026

Uploaded by SANS