One of the causes of transient ischemic attack or ischemic stroke are mass formations in the left heart. One of the predisposing factors for thrombosis is the presence of the Leiden mutation, as the most common form of hereditary thrombophilia in the European population. At the same time, spontaneous dissection of the coronary arteries (SCA) can be one of the reasons of an acute vascular accident. Of particular difficulty is differential diagnosis, which requires additional examination methods (intravascular ultrasound, optical coherence tomography) in addition to coronary angiography. The presented clinical case describes the diagnosis and successful treatment of spontaneous anterior interventricular artery dissection, left ventricular thrombosis, detection of factor V Leiden gene mutation in a young man with a history of transient ischemic attack