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.