Coronary artery dissection

Background

Illustration showing coronary artery dissection with formation of a hematoma (purple) within the walls of the coronary artery.
  • Spontaneous tear in the intimal wall of a coronary artery leading to a false lumen and intramural hematoma, similar to aortic dissection
  • Much more common in young women
  • Usually presents as an Anterior MI with ST changes in anterior Precordial leads (V1-V3)

Causes

  • Hormonal changes in vessel wall (eg pregnancy, contraceptives)
  • Shear forces
  • Fibromuscular dysplasia
  • Underling connective tissue disorder
  • Iatrogenic (during coronary angiography)

Clinical Features

Differential Diagnosis

ST Elevation

Evaluation

Management

Disposition

  • Admit

See Also

References

  1. Saw J, Aymong E, Sedlak T, et al. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv 2014; 7:645.