Methods:
Chest plain radiograph did not reveal any acute cardiopulmonary abnormalities. The initial ECG showed T-wave inversion in lead V1 and biphasic T-wave in lead V2 (Figure 2A) , while the subsequent ECG one hour later showed persistent T-wave inversion in lead V1, V2, but a new biphasic T-wave in lead V3 (Figure 2B) . Cardiology was consulted who recommended serial cardiac troponin which continued to increase to 0.241 ng/mL, 0.650 ng/mL, and 0.728 ng/mL. The patient was given an aspirin load of 324 mg and urgent echocardiography revealed a mildly reduced ejection fraction of 45% with akinetic apical anterior, apical septal, apical inferior, apical lateral and apex left ventricular wall segments (Figure 3A-B) . She was started on a heparin, eptifibatide, and nitroglycerin. A cardiac catheterization was performed and revealed coronary dissection in the left main coronary artery from the ostium to the distal in addition to a second dissection in the proximal and mid LAD (Figure 4A-B) . Three drug-eluting stents, one in the left main coronary and two in the proximal and mid LAD, were placed without complications. The patient was started on aspirin 81 mg daily, clopidogrel 75 mg daily, atorvastatin 40 mg daily, lisinopril 5 mg daily, and metoprolol succinate 50 mg daily. Initial FMD workup including computed tomography angiography (CTA) of the head, neck and chest was unremarkable. The patient was safely discharged home with plans to enroll in the SCAD registry and repeat echocardiogram to assess for left ventricle recovery. Unfortunately, the patient was lost to follow up despite multiple attempts to establish communication with the patient by the cardiology team.