Sudden Cardiac Death Due to Triple Vessel Coronary Dissection

A 55-year–old white woman with no previous medical history collapsed when driving home in her car after a leisurely swimming session. She had sufficient time to communicate to a bystander a recent history (1 week prior) of chest pain for which she had not consulted a physician. She took no medication and had no cardiovascular risk factors. Cardiorespiratory reanimation was performed for 40 minutes by bystanders without success, and the woman was pronounced dead by the time professional help arrived on the scene. No ECG or other noninvasive examinations of her heart are thus available. At autopsy, no Marfan or Ehlers-Danlos syndrome was noted. The heart weighted 310 g (body weight 55 kg, height 165 cm, and body-mass index 20.2). No vascular or myocardial abnormalities were noted and no cardiac hypertrophy (left ventricle 1.3 cm and right ventricle 0.5 cm). Examination of the coronary tree revealed no atherosclerotic changes but complete occlusion of all 3 main coronary arteries: the right coronary artery …