Spontaneous coronary artery dissection (SCAD) is an increasingly recognized non-atherosclerotic cause of acute coronary syndrome and an important mechanism of myocardial infarction with non-obstructive coronary arteries (MINOCA), particularly in younger women without traditional cardiovascular risk factors. SCAD results from separation of the layers of the coronary arterial wall, with formation of a false lumen and impaired myocardial perfusion. Conventional coronary angiography, although the first-line diagnostic tool, may not adequately identify intramural disease; therefore, intracoronary imaging with optical coherence tomography or intravascular ultrasound, and cardiac magnetic resonance in selected MINOCA patients, are used to refine diagnosis and identify the underlying mechanism. Treatment is usually conservative, as most dissections heal spontaneously. Observational data suggest that b-blockers may reduce recurrence, especially in patients with hypertension or left ventricular dysfunction. Revascularization with stenting or coronary artery bypass grafting is reserved for patients with ongoing ischemia or hemodynamic instability. Despite a favorable overall prognosis, recurrence – particularly in the presence of fibromuscular dysplasia and uncontrolled hypertension – remains a concern.