Spontaneous coronary artery dissection in a man with intense coughing spasms

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction of emerging significance, which occurs predominantly in young women without coronary artery disease risk factors. Valsalva-like activities such as coughing have been identified as potential triggers for the development of SCAD. We report a case of SCAD in a man in whom the only identifiable predisposing factor was excessive coughing. He presented with atypical chest pain. Troponin I peaked at 29 ng/mL, and ECG showed no evidence of ischaemic changes. He underwent cardiac catheterisation via the radial approach, which revealed a linear second obtuse marginal dissection. He was managed conservatively with medical therapy with a good outcome.