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The final diagnosis was spontaneous coronary artery dissection (SCAD) starting in the mid LAD and continuing distally where it wraps around the apex. SCAD wasn't on my differential per se , but in retrospect it should have been. Most patients presenting with SCAD report a preceding emotional or physical stressor. Buller, C.
But it also shows a massive area of total ischemia in the LAD territory: CT shows the infarct The CT is with contrast, which increases density (which looks more white). It was not SCAD (coronary dissection) Highest troponin I was 37,000 ng/L, but it was not measured to peak. No ECG was recorded after pain resolution.
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