Spontaneous coronary artery dissection (SCAD) is an uncommon cause of myocardial infarction (MI). It presents clinically either as sudden cardiac death, as in this case, or as an acute coronary syndrome with clinical symptoms, changes in the ECG (ST segment elevation MI or non-ST elevation MI) and a rise in cardiac biomarkers. Although initially thought to be very rare, SCAD is increasingly recognised as a cause of MI in women. Both clinical awareness of SCAD as a clinical diagnostic entity and the use of a sex-specific 99th centile may improve the rate of diagnosis. Investigation is by angiography but treatment is conservative although this approach is based on expert consensus rather than clinical trial evidence.1

The measurement of ‘cardiac enzymes’ for the diagnosis of MI has now been entirely replaced by the use of immunoassay for the cardiac troponins (cTn) and resulted in a paradigm shift in the diagnosis of MI. Approximately 33% of patients with …