Spontaneous coronary dissection usually occurs in middle-aged women, during pregnancy and postpartum. Proposed management strategies are most often based on invasive procedures such as percutaneous transluminal intervention with stenting, or surgical revascularization. We report a case of coronary dissection of the main stem artery occurring after intensive exercise, showing a rapid regression under conservative medical treatment. This case and the review of the literature emphasize that in case of non-occlusive coronary dissection, a conservative approach with a careful follow-up may be a strategy to consider.