case_images: PMC11774130_01
case_images: Initial 12-lead EKG on admission.. The 12-lead EKG on admission shows normal sinus rhythm with heart rates at a baseline of 55-60 bpm. This EKG was obtained during the patient's cardiac troponin elevation but showed no evidence of any ST or other ischemic changes.
case_images: cureus-0017-00000078127-i01.jpg
case_images: PMC11774130_01_cureus-0017-00000078127-i01.jpg
case_images: FIG1
case_images: Given his intermittent chest pain, the patient received a 12-lead electrocardiogram (EKG) which showed normal sinus rhythm with no ischemic or dynamic EKG changes, suggesting that a transmural infarct was less likely (Figure 1).
case_images: Angiographic films demonstrating distal spontaneous coronary artery dissection.. Left: Curvy black arrows pointing to the distal left circumflex demonstrating coronary tortuosity.. Right: Gray box in the distal left anterior descending distribution indicating high degree of coronary tortuosity and spontaneous coronary artery dissection.
case_images: cureus-0017-00000078127-i02.jpg
case_images: PMC11774130_01_cureus-0017-00000078127-i02.jpg
case_images: FIG2
case_images: Given the aforementioned troponin elevation, the patient was taken for an urgent left heart catheterization (LHC), which demonstrated mild non-obstructive coronary disease but a distal spontaneous coronary artery dissection in the distribution of the left anterior descending artery (Figure 2).
case_images: Computed tomography angiography (CTA) of the head and neck.. CTA of the head and neck demonstrating tortuous carotid arteries, significant stenosis, and bilateral bulbar dilation; all features that may indicate underlying fibromuscular dysplasia.. The red arrow demonstrates significant stenosis of the left carotid artery. The green arrow indicates significant carotid bulbar dilation.
case_images: cureus-0017-00000078127-i03.jpg
case_images: PMC11774130_01_cureus-0017-00000078127-i03.jpg
case_images: FIG3
case_images: While the classic "string of beads" finding was not appreciated, the CTA head and neck did demonstrate bilateral carotid tortuosity, significant bilateral non-atherosclerotic carotid stenosis, and bilateral carotid bulb dilation which are all consistent with FMD angiography (Figure 3).