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SCAD — RACP Adult Medicine MCQ

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HardCardiologySCADRACP Adult Medicine

A 48-year-old woman presents with acute onset chest pain and ST elevation in leads V1–V4. Coronary angiography reveals no obstructive coronary artery disease but a smooth tapering occlusion of the mid-LAD. What is the most likely diagnosis?

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Correct answer: B — Spontaneous coronary artery dissection (SCAD)

SCAD is a non-atherosclerotic cause of ACS that predominantly affects young to middle-aged women. Angiography typically shows smooth tapering or a dissection flap. The 2025 Australian ACS guideline includes specific guidance for managing MI due to non-atherosclerotic causes including SCAD. Conservative management is generally preferred unless there is ongoing ischaemia.

Reference: NHF/CSANZ – 2025 – Australian Clinical Guideline for Diagnosing and Managing ACS