Spontaneous coronary artery dissection: An unusual case of myocarditis mimicry with delayed apical thrombus

Abstract

Introduction: We discuss the occurrence of a unique triad of spontaneous coronary artery dissection (SCAD), myocarditis, and thrombus in a patient without risk factors. Case Report: A 26-year-old male referred to our facility for invasive intervention after presenting with sudden onset chest pain for which an initial electrocardiogram (ECG) showed an anterolateral ST-segment elevation myocardial infarction and a troponin-I level of 425,923 ng/dL. Upon arrival, an urgent coronary angiography revealed a type II spontaneous SCAD of the left anterior descending artery with extensive myocarditis on cardiac magnetic resonance imaging with a subsequent development of an apical thrombus. He was medically optimized and discharged in a stable state. Conclusion: The complex interplay between SCAD, myocarditis, and thrombus development remains unclear and though rare, it serves as a relevant hypothesis-generating basis for future inquiry. Awareness of the concomitant occurrence of these entities is paramount to facilitating tailored management of affected patients.