Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial ischaemia with a high mortality. It most commonly occurs in young women with few risk factors for atherosclerosis. Presentation is varied, from sudden death to chest pain with features of myocardial ischaemia. The case presented highlights the dilemma of the need to treat a myocardial infarction within an acceptable time frame versus exploring a rare but entirely possible pathology, which may only be diagnosed in a tertiary referral centre a minimum of 90 min away.