Abstract
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a rare and often overlooked cause of acute coronary syndrome. Most cases present with myocardial infarction, and initial presentation with sustained ventricular tachycardia (VT) is exceedingly uncommon. CASE SUMMARY: A 65-year-old man presented with sustained monomorphic VT and hypotension. After successful cardioversion, elevated cardiac biomarkers prompted further evaluation. Coronary angiography with optical coherence tomography confirmed SCAD of the proximal left anterior descending artery. The patient underwent percutaneous coronary intervention with drug-eluting stent placement. Cardiac magnetic resonance imaging revealed dilated cardiomyopathy with apical thrombus. DISCUSSION: VT in SCAD results from ischemia due to intramural hematoma or dissection. Intracoronary imaging plays a vital role in confirming diagnosis and guiding management in atypical cases. CONCLUSIONS: This case highlights the importance of considering SCAD in the differential diagnosis of unexplained VT, particularly in patients without diffuse coronary artery disease, and it emphasizes the role of advanced imaging and early intervention in improving clinical outcomes.