DISCUSSION: Spontaneous coronary artery dissection is a very rare cause of acute coronary syndrome (ACS) representing 0.1 - 0.4% of the cases, mostly women. Spontaneous dissection involving the LMCA is rarely diagnosed and is assumed to be incompatible with survival. Indeed, a literature search shows fewer than 25 cases diagnosed in patients who were still alive. The pathogenesis is poorly understood, however potential predisposing factors include connective tissue disorders, fibromuscular dysplasia and post-partum state. It is notable that while spontaneous dissection of normal coronary arteries has been reported in association with strenuous exertion, this case suggests an association with pure emotional stress. Optimal management is uncertain given the rarity of cases but there have been reports of treatment with conservative management, percutaneous coronary intervention, fibrinolytic therapy and CABG.