Spontaneous coronary artery dissection--the separation of the coronary artery wall layers caused by an intramural hematoma--frequently causes an acute coronary syndrome (ACS) and sudden cardiac death. The diagnosis is made at angiography by the 'tram-track' appearance of the contrast media in the true and false lumina, separated by a radiolucent intimal flap. Here we report two cases of spontaneous coronary artery dissection-related ACS managed with minimally aggressive treatment.