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

## TL;DR

This paper discusses a case where a middle-aged woman with chest pain was correctly diagnosed with a rare heart condition called SCAD, distinguishing it from similar conditions like myocarditis.

## Contribution

The paper highlights the diagnostic challenges of SCAD and emphasizes the importance of accurate diagnosis to avoid harmful treatment.

## Key findings

- SCAD can mimic acute coronary syndrome and myocarditis, leading to misdiagnosis.
- Coronary angiography was crucial for confirming the diagnosis in this case.
- Patients without traditional risk factors can still develop SCAD.

## Abstract

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.