DISCUSSION: Spontaneous Coronary Artery Dissection (SCAD) occurs more frequently in women (82%) and has a prevalence of only 0.2% on cardiac catheterization series.1, 2 SCAD is associated with connective tissue disorders such as fibromuscular dysplasia and Ehlers-Danlos. Multivessel dissection occurs in only 23% of cases.2 STEMI is the most common presentation (49%), but chronic, stable ischemic symptoms or pulseless cardiac arrest, as was seen in our patient, may occur as well. Clinical presentation usually ranges from typical angina symptoms to STEMI to sudden cardiac death. PCI is associated with high rates of complications and may be deferred, as in this case, since in-hospital mortality is low regardless of initial treatment strategy. Spontaneous resolution of the dissected coronaries is commonly seen if follow-up coronary angiography is performed. Thus, our patient had an uncommon presentation of a rare disease: a male with multi-vessel involvement of unknown etiology presenting with chronic stable ischemic symptoms which progressed to pulseless cardiac arrest.