Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 9 3 2025 10 14 e27 e27 Alaina Pupulin University of Toronto, Department of Family Medicine, 1 King’s College Cir, Toronto, ON, Canada. Rajani Vairavanathan Michael Garron Hospital, Department of Emergency Medicine, 825 Coxwell Ave, Toronto, ON, Canada. Jefferson Hayre Michael Garron Hospital, Department of Emergency Medicine, 825 Coxwell Ave, Toronto, ON, Canada. 2025 05 07 2025 05 15 Spontaneous coronary artery dissection (SCAD) is a rare but life-threatening cause of acute coronary syndrome, particularly in young women with few traditional risk factors for atherosclerosis. SCAD is often underrecognized due to its atypical presentation which can lead to misdiagnosis or delayed diagnosis in emergency settings. We present a case of a 40-year-old female who presented to the emergency department with acute chest pain and was found to have ST-elevation myocardial infarction (STEMI) due to SCAD. This case highlights the importance of considering SCAD in the differential diagnosis of acute coronary syndrome in young patients, especially females, and the need for increased awareness among emergency physicians to optimize patient outcomes and reduce recurrence risks. This case also emphasizes the importance of recognizing SCAD as a distinct entity from atherosclerotic ACS, as it requires a different management approach, particularly in the initial steps of care. https://fem.tums.ac.ir/index.php/fem/article/view/1593 https://fem.tums.ac.ir/index.php/fem/article/download/1593/532