The manifestation of an acute coronary syndrome in women in the postpartum period is a rare but important clinical scenario, which, because of its multiple possible aetiologies, requires a different approach to management on the part of the clinician. Spontaneous coronary artery dissection (SCAD) is the most likely cause of an acute coronary syndrome in women in the puerperium. Unfortunately there is no medical consensus on the correct management pathway of such patients, but there is evidence that these patients have an improved prognosis when referred for bypass surgery or percutaneous intervention.