Abstract
Background
Saw-tooth cardiomyopathy is an exceptionally rare form of left ventricular dysplasia characterized by distinctive myocardial serrations. Although associated with heart failure, arrhythmias, thromboembolic events, and mitral valve prolapse, its coexistence with spontaneous coronary artery dissection (SCAD) has not previously been reported.Case summary
A 25-year-old man presented with severe ischemic chest pain, ST-segment elevation, and Society for Cardiovascular Angiography & Interventions Stage C cardiogenic shock with acute pulmonary edema. Coronary angiography demonstrated spontaneous coronary artery dissection, while cardiac magnetic resonance confirmed extensive ischemic myocardial injury and characteristic features of saw-tooth cardiomyopathy. He was managed conservatively with guideline-directed medical therapy. Follow-up imaging demonstrated persistent severe left ventricular systolic dysfunction despite negative extended genetic testing.Discussion
Multimodality imaging distinguished acute SCAD-related myocardial infarction from a preexisting structural cardiomyopathy.Take-home messages
Acute SCAD may unmask previously unrecognized structural myocardial abnormalities. Multimodality imaging is essential for distinguishing acute ischemic myocardial injury from underlying cardiomyopathy and guiding management. Saw-tooth cardiomyopathy remains an exceptionally rare myocardial phenotype with an uncertain genetic basis and long-term prognosis, warranting genetic evaluation and longitudinal follow-up when clinically indicated.