Spontaneous coronaryarterydissection: a neglected causeofacutemyocardial ischaemia andsudden death

1996 
Spontaneous coronary arterydissection is a rare cause of acute myocardial ischaemia. Eightconsecutive fatal cases whichoccurred inwomen aged34-54 years (mean43)are described. The dissection involved theleft anterior descending coro- nary arteryinfour, theleft maintrunkin two,theright coronary arteryinone,and bothleft anterior descending andcircum- flexarteries inone. Theclinical presenta- tionwas suddendeathinsixcases,and acute myocardial infarction in two. Diagnosis was madeatnecropsy inevery casebutone,inwhichcoronary dissection was diagnosed duringlifeby selective coronary angiography. The onlyascer- tained riskfactor was hypertension inone patient; none ofthewomen was inthe puerperium, andMarfansyndrome was excludedin all.Histology showed a haematomabetweenthecoronary tunica mediaandadventitia, thatflattened and occluded thelumen;a coronary intimal tear was detected in onlytwo cases. Unusualhistological findings were cystic medialnecrosis inone case,eosinophilic inflammatory infiltrates in four,and angiomatosis ofthetunicaadventitia in one. Patients dyingofspontaneouscoro- nary dissection are usually middleaged women, withno coronary atherosclerosis and apparently no riskfactors. Spon- taneous coronary arterydissection is unpredictable, andsuddendeathisthe usualmode of clinical presentation. Promptdiagnosis andlifesaving treat- ment isfarfrombeingachieved.
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