Recurrent acute coronary syndrome in a patient with spontaneous coronary artery dissection and fibromuscular dysplasia.

A 51-year-old woman who presented in June 2010 with acute coronary syndrome (ACS) and anterior wall motion abnormality on the echocardiogram but was found to have an insignificant angiogram. Eight years later she presented again with ACS and evidence of worsening cardiac wall motion affecting a similar territory; however, the angiogram revealing spontaneous coronary artery dissection of the distal left anterior descending artery. Extravascular screening revealed evidence of multifocal fibromuscular dysplasia. We suggest offering vascular screening for fibromuscular dysplasia in young women who present with ACS and normal angiograms, after weighing in risks and benefits.