PMC9195061_01
12-lead EKG revealing acute ST-elevation myocardial infarction, with ST-elevations noted in the lateral and inferior leads.
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An EKG at that time revealed ST-elevations in the inferolateral leads (Fig. 1), with an elevated high-sensitivity troponin (6793 ng/L; reference range: 0-34 ng/L).
Coronary angiography (A) Non-obstructive disease of the left coronary distribution including the left anterior descending (LAD) artery, circumflex (LCx) artery and their branches. (B) Right dominant coronary system with right coronary artery (RCA) giving off the posterior descending artery (RPDA), with an area of moderate to severe tortuosity in the mid RPDA. (C) Focal spontaneous coronary artery dissection involving the mid to distal RPDA (box) and an area of moderate narrowing, with TIMI-3 flow in the distal RPDA (arrow).
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Left heart catheterization revealed SCAD involving the mid to distal right posterior descending artery (RPDA) with TIMI-3 flow in the distal RPDA (Fig. 2), along with distal inferoapical severe hypokinesis and preserved left ventricular (LV) systolic function.