Coronary Artery Dissection, Spontaneous

Clinical Features

Spontaneous coronary artery dissection, a rare cause of myocardial infarction, occurs in relatively young persons with a striking predilection for women. In an analysis by DeMaio et al. (1989), 52 of 62 autopsy cases were in women, with a mean age of 40 years. As in dissection of the aorta, there is a strong tendency for this rare event to occur in women in the postpartum state.

Wisecarver et al. (1989) described sudden death in a 47-year-old white woman due to dissection of the distal segment of the left anterior descending coronary artery. There was marked involvement of the coronary arterial walls with cystic degeneration of the media with accumulation of glycosaminoglycans as demonstrated by Alcian blue staining. The patient's mother and brother had abdominal aortic aneurysms (100070).

Bonnet et al. (1986) studied cultured fibroblasts from a 32-year-old woman who had 2 episodes of myocardial infarction, 2 and 4 months after delivery, which were shown by coronary arteriography to be due to 2 consecutive coronary artery dissections. They concluded that there was reduced total collagen synthesis in the cultures of the patient as compared with those of controls; that the ratio between types I and III procollagen was not altered; and that the rate of conversion of procollagen into collagen was higher in the pathologic cultures.