Spontaneous coronary artery dissection (SCAD) and coronary artery rupture (CAR) are rare yet important causes of myocardial infarction with significant morbidity and mortality. Despite the serious nature of these pathologies, the exact incidence rates of SCAD and CAR remain difficult to determine due to underdiagnosis and misclassification. Evolution of imaging techniques and increasing clinical awareness have led to improved detection rates. The pace of attainment of knowledge acquisition has been rapid, but ongoing challenges include accurately diagnosing these pathologies and improving outcomes. Both these conditions cause physical and psychosocial distress. Management strategies for these two critical conditions vary. SCAD often starts with conservative medical therapy, while severe cases may require surgical intervention such as coronary artery bypass grafting. CAR generally warrants immediate surgical repair due to its acute nature. The prognosis and outcomes for SCAD and CAR patients are impacted by a variety of factors, including underlying conditions, management strategies, and patient characteristics. Long-term follow-up studies indicate that while many patients can have favourable outcomes, the risk of recurrence and complications remains considerable. Identifying and managing risk factors is pivotal for improving long-term prognosis. Long-term management focuses on recurrence prevention and management of symptoms through medical therapy, cardiac rehabilitation, and psychological support, with regular follow-up and imaging.