The Great Cardiac Masquerade: Distinguishing Acute Coronary Syndrome From Myocarditis and Spontaneous Coronary Artery Dissection in a Middle-Aged Woman With Chest Pain.

Spontaneous coronary artery dissection (SCAD) is a rare, nonatherosclerotic cause of acute coronary syndrome (ACS), resulting from the formation of a false lumen and propagation of an intramural hematoma within the coronary artery wall. This process can lead to luminal narrowing, myocardial ischemia, and anginal symptoms. Because SCAD often presents with clinical and electrocardiographic features similar to obstructive ACS, as well as other close mimics such as myocarditis, misdiagnosis is common. Given the differences in management strategies, this can lead to suboptimal or even harmful outcomes. Here, we present the case of a 54-year-old woman with no traditional cardiovascular risk factors who presented with chest pain, had a nondiagnostic echocardiogram arguing against myocarditis, and was ultimately diagnosed with SCAD on coronary angiography.