Introduction:
Spontaneous Coronary Artery Dissection (SCAD) is defined as an
epicardial coronary artery dissection not associated with
atherosclerosis, trauma or iatrogenic causes1,2. SCAD
is a rare cause of acute coronary syndrome(ACS) that can affect single
or multiple coronary vessels3,4. Complications of SCAD
include ongoing ischemia, cardiomyopathy, arrhythmias and sudden cardiac
death3,4. Coronary angiography is the primarily
imaging modality for diagnosing SCAD4. Medical
management and conservative therapy for SCAD typically results in
favorable outcomes5, but there is a high recurrence
rate of major cardiovascular events with the majority being
SCAD2,6. Major adverse cardiovascular events (MACE)
can range from recurrent MI, recurrent SCAD, unanticipated
revascularization, congestive heart failure, stroke, and death. To date,
there are no definite primary or secondary preventative measures for
either SCAD or the associated cardiovascular complications. Our case
presents a patient with an underlying connective tissue disorder who
developed recurrent SCAD in multiple coronary arteries. This resulted in
recurrent episodes of ventricular fibrillation and cardiac arrest
despite optimized medical therapy. We discuss the role of implantable
cardiovert-defibrillator (ICD) for secondary prevention in patients with
recurrent SCAD.