A coronary artery dissection occurs when there is injury to the intima resulting in its separation from the media creating a false lumen. This can result in hemodynamically significant stenosis ...

The right coronary artery can also be involved causing an inferior myocardial infarction. Rupture of the ascending aortic dissection into the pericardium can cause a rapid pericardial effusion ...

Given the patient's age, medical history, and lack of obvious risk factors, there was a substantial possibility that the lesion was either a spiral dissection or a prolonged coronary vasospasm.