Extensive spontaneous coronary artery dissection complicated by ventricular tachycardia storm and cardiogenic shock

A healthy man in his 40s presented with acute anterolateral ST-segment elevation myocardial infarction after sudden-onset chest pain during a coughing episode. Coronary angiography and intravascular ultrasound revealed extensive spontaneous coronary artery dissection (SCAD) of the left anterior descending artery with Thrombolysis in Myocardial Infarction II distal flow. He was managed conservatively, but his course was complicated by severe left ventricular systolic dysfunction, apical thrombus and a ventricular tachycardia storm leading to cardiogenic shock. He required repeated emergency direct-current cardioversions, intravenous amiodarone, lidocaine and intra-aortic balloon pump support. Cardiac magnetic resonance imaging confirmed extensive myocardial infarction. Clinical recovery was achieved without revascularisation, and an implantable cardioverter-defibrillator was implanted for secondary prevention alongside guideline-directed heart failure therapy. At follow-up, he remained clinically stable. This case highlights that SCAD, although uncommon in men, can present with life-threatening complications and that carefully tailored conservative management with multidisciplinary input may achieve favourable outcomes.