The clinical of SCAD surrounds the broad spectrum of myocardial ischemia presentation ranging from stable angina to Acute Coronary Syndrome (ACS).Its prevalence has been reported higher among patients with ACS (3-4%) compared with those with stable symptoms (0.3%) (75). STEMI presentation (26-87%) is more frequent than NSTEMI one (43). Chest pain is the most reported symptom during presentation (91-100%) as a result of the combination of pain derived from ischemia and from the dissection itself: this pain may be even atypical (when pain is described as "burning", "tearing" or "positional"). Other recurrent symptoms are dyspnea (25-57%) and syncope (23%) (42,73). Life-threating ventricular arrhythmias requiring emergent defibrillation have been reported up to 14% of cases (42) while bradyarrhythmias were less common (37). Even cardiogenic shock and congestive heart failure on presentation may be reported (76). In rare cases, SCAD may be completely asymptomatic and discovered incidentally on coronary angiography (77).