Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and is often associated with fibromuscular dysplasia (FMD). We describe the case of a 55-year-old woman with a prior history of SCAD who presented with acute chest pain. Angiography revealed a new dissection in the diagonal branch of the left anterior descending artery with preserved flow, but her condition worsened with recurrent pain and ischemic electrocardiographic changes, ultimately requiring intra-aortic balloon pump support. She stabilized and was discharged on medical therapy, with plans for further evaluation of possible FMD. This case highlights the clinical complexity of recurrent SCAD, the importance of considering family history in risk assessment, and the challenges of management, particularly regarding revascularization strategies versus conservative therapy. Given the association between SCAD and FMD, screening for underlying arteriopathies is crucial. Recognition of recurrent SCAD in patients with few traditional cardiovascular risk factors is essential for timely diagnosis, appropriate management, and risk stratification.