Spontaneous coronary artery dissection (SCAD) is an increasingly recognised cause of acute coronary syndrome predominantly affecting women (>
90% of cases) that is frequently associated with other arteriopathies, such as fibromuscular dysplasia (FMD) and migraine. We present a case of multi-vessel SCAD in a woman in her 40s presenting with myocardial infarction in whom incidental widespread FMD was found, including a massive right renal artery aneurysm requiring ex vivo resection, repair and autotransplantation. The case underscores the need for routine angiographic screening for FMD, which has a shared genetic risk with SCAD, and is associated with aneurysms, stenoses and hypertension.