A woman in her early 40s presented with acute pleuritic chest pain, shortness of breath, and nausea that started several hours after a flight. She was noted to have tachycardia (110 beats/min) and hypoxemia (90% receiving room air) with a blood pressure of 106/81 mm Hg. Results of an electrocardiogram revealed sinus tachycardia with premature ventricular contractions, subcentimeter ST-segment elevation in leads I and aVL and 1-mm ST-segment depression in leads II, III, aVF, and V5 through V6. This angiography video after emergent cardiac catheterization revealed spontaneous coronary artery dissection of the left main coronary artery. Spontaneous coronary artery dissection has been increasingly recognized as an important cause of acute coronary syndromes, especially in young healthy women without traditional cardiovascular risk factors.
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