past medical history of HTN, morbid obesity and OSA s/p gastric bypass

presented with chest pain precipitated by bad family news her blood pressure at home and found it to be 180/110 and was found to have EKG showing new anterior T-wave inversions, and high-sensitivity troponin levels increasing from 207->279 -> 973 ->1280.

NSTEMI 4 months prior   and spontaneous coronary artery dissection during coronary catheterization.

involving the left anterior descending, 1st diagonal, left circumflex, 2nd obtuse marginal, and right coronary arteries. now on aspirin, HFpEF, depress/anxiety,

CORONARY CIRCULATION:
Right Dominant
Left Main: Mild Luminal Irregularities less than 30%
LAD:
Distal LAD: Lesion 100 %, consistent with SCAD
1st Diagonal: Lesion 90 %
LCX:
1st Obtuse Marginal: Lesion 50 % with circumferential, extraluminal
contrast staining
2nd Obtuse Marginal: Lesion 100 % distal portion of branch
RCA:
Mid Right Coronary Artery: Lesion 70 %, diffuse, long lesion
suspicious for SCAD