Significant number of MIs are related to non-athero-sclerotic mechanisms, which require specific diagnostic and therapeutic strategies (see figure 1).

Takotsubo syndrome, coronary vasospasm, myocarditis, coronary embolism and spontaneous coronary artery dissection (SCAD) are well-known non-atherosclerotic causes of acute myocardial injury or infarction.

SCAD is an increasingly recognised cause that predominantly affects relatively young women and may be responsible for 1–4% of acute coronary syndromes overall and up to a third of heart attacks in women under 50.^1-4