Recurrent Spontaneous Coronary Artery Dissections in a Male Patient With Fibromuscular Dysplasia

Spontaneous coronary artery dissection (SCAD) is a rare presentation of acute coronary syndrome characterized by a tearing of the wall of the epicardial coronary artery, leading to myocardial ischemia. SCAD predominantly affects young and middle-aged women, but young men without significant cardiovascular risk factors can also present with the disease. In the setting of fibromuscular dysplasia, men may be at a higher risk for recurrence. We present the case of a young man with a history of fibromuscular dysplasia and prior SCAD in the diagonal branch and right posterolateral artery who presented with exertional chest pain. Further evaluation revealed a recurrent SCAD of the distal right coronary artery despite being on conservative management with aspirin and beta-blockers. There is a need to study the pathophysiology of fibromuscular dysplasia and SCAD in men further and develop medical therapies to treat recurrent SCAD.