Spontaneous coronary artery dissection (SCAD) is atherosclerotic or non-atherosclerotic in origin. Eosinophilic infiltrate is identified in coronary artery adventitia in non-atherosclerotic SCAD. We postulate that a systemic inflammatory state causes SCAD in younger women who do not have significant coronary artery disease risk factors. We report a case series of 13 patients presenting with SCAD from ages 26-48 with follow up from 1 month to 13 years. Most patients did not have conventional risk factors for coronary artery disease (CAD). Approximately 50% of the patients developed recurrent dissection within the first 2 weeks of an index event, but < 25% were symptomatic during follow up. All patients were alive at follow up. Systemic inflammatory state was observed in 80% of patients who developed early recurrent dissection. SCAD should be strongly suspected in younger women presenting with acute coronary syndrome without CAD risk factors. Coronary dissection may recur within first 2 weeks, but patients have good long-term survival without new episodes of dissection. Broad rheumatologic and connective tissue disease work-up should be considered in young females presenting with SCAD.