Non-atherosclerotic spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. Here, we report a case of acute ischemic mitral regurgitation (MR) due to SCAD of the left main coronary artery. Given the extent of the acute ischemic MR and multi-vessel disease, the decision was made to pursue coronary artery bypass graft surgery and annuloplasty mitral valve ring repair.