Spontaneous coronary artery dissection (SCAD) is a rare but significant cause of acute coronary syndrome (ACS), typically affecting young women without traditional cardiovascular risk factors. We report the case of a 26-year-old woman, using only oral contraceptives, who presented with oppressive precordial pain, diaphoresis, and dyspnea. Electrocardiography demonstrated ST-segment elevation in leads V1–V2 and depression in inferior leads. Coronary angiography performed 24 hours after symptom onset revealed dissection of the left anterior descending artery, extending from the ostium to the proximal third, with 90% obstruction, intramural thrombus, and associated anteroapical akinesia of the left ventricle. Due to hemodynamic stability and absence of persistent pain, a conservative management strategy was adopted, consisting of dual antiplatelet therapy with acetylsalicylic acid and clopidogrel, as well as anticoagulation with enoxaparin. Eight days later, repeat angiography combined with intravascular ultrasonography confirmed the dissection but demonstrated marked improvement of stenosis to 50% and the presence of an intramural hematoma with a thrombosed false lumen. The patient was discharged asymptomatic 12 days after symptom onset, with normal markers of myocardial necrosis, and remained on dual antiplatelet therapy with planned imaging follow-up. SCAD can present with all clinical manifestations of ACS and may often be overlooked, with diagnosis frequently established only at necropsy. It predominantly affects young women, frequently involving the left anterior descending artery, while in men it is usually associated with risk factors and more often involves the right coronary artery. The optimal management of SCAD remains uncertain, but intracoronary imaging techniques play a fundamental role in confirming the diagnosis, guiding treatment decisions, and assessing prognosis. This case reinforces the need to consider SCAD in the differential diagnosis of ACS in young patients without risk factors and highlights the importance of tailored therapeutic strategies based on clinical stability and imaging findings.

Cybelle Nunes Leão Mota received her Medical degree from the University Center of Volta Redonda (UniFOA) in 2014, followed by a residency in Internal Medicine at Hospital Santa Isabel (2018) and a residency in Cardiology at the Institute of Social Security of the State of Minas Gerais – Hospital Governador Israel Pinheiro (2020). She is currently a cardiologist at Clínica Cardio Prime, a clinical preceptor at the University of Gurupi (UnirG), and also serves at Policlínica João Coelho de Azevedo. She was awarded 1st place in the Case Report – Resident Physician category at the Congress of the Sociedade Mineira de Cardiologia (2019). She has authored scientific publications in national and international journals and presented works at major cardiology congresses.