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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.
It was not SCAD (coronary dissection) Highest troponin I was 37,000 ng/L, but it was not measured to peak. The Initial ECG in Case #1: The ECG in Figure-1 shows sinus tachycardia at ~110/minute with markedly increased QRS amplitude and marked chest lead ST elevation. This was ruptured plaque with thrombus.
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