case_images: PMC10166221_01
case_images: Initial electrocardiogram on presentation. Electrocardiogram showed left anterior fascicular block with T wave inversion in the lateral leads.
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case_images: PMC10166221_01_jchimp-13-02-063f1.jpg
case_images: f1-jchimp-13-02-063
case_images: Electrocardiogram demonstrated a left anterior fascicular block with lateral ischemic changes (Fig. 1).
case_images: Coronary angiogram 6 months prior to presentation. Image A shows coronary angiogram showing LAD dissection with proximal entry point (orange arrow) with distal to apical extension (red arrows). Image B shows complete LAD obstruction with no distal collaterals (red arrows) 24 h post initial presentation.
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case_images: PMC10166221_01_jchimp-13-02-063f2.jpg
case_images: f2-jchimp-13-02-063
case_images: Her clinical course was complicated by a ventricular fibrillation arrest due to distal propagation of the dissection and complete occlusion of the LAD (Fig. 2).
case_images: Coronary angiogram during current presentation. Coronary angiogram demonstrating LCx (orange arrow) with bifurcating OM1 showing a Type II SCAD (red arrows) and healed LAD with distal atherosclerotic disease (blue arrows).
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case_images: PMC10166221_01_jchimp-13-02-063f3.jpg
case_images: f3-jchimp-13-02-063
case_images: Emergency cardiac catheterization showed a Type II SCAD involving the large, bifurcating OM1 (obtuse marginal) branch with distal TIMI 0 flow, and a prior healed LAD dissection with distal TIMI III flow (Fig. 3).