Spontaneous Coronary Artery Dissection in an Elderly Postmenopausal Nigerian Woman With Recurrent Chest Pain: A Case Report

Spontaneous coronary artery dissection (SCAD) is an unusual etiology of myocardial infarction and sudden cardiac death (SCD) with a different pathophysiological mechanism. Often associated with younger women, where the hormonal milieu of estrogen and progesterone has been implicated, postmenopausal SCAD is, however, uncommon with unknown management outcomes. We report the case of a 75-year-old postmenopausal woman presenting with recurrent chest pain, found to have SCAD on coronary angiography, and managed conservatively. We believe this represents one of the earliest documented cases of postmenopausal SCAD in Nigeria diagnosed angiographically. It seeks to enhance local awareness, review current diagnostic and management modalities, and contribute to the expanding body of literature. SCAD can present as acute coronary syndrome (ACS) in young women, where the hormonal milieu has been implicated. Postmenopausal SCAD is, however, uncommon, and a high index of suspicion is essential to prevent adverse outcomes.