Coronary artery dissection

Background

  • 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

  • Chest or shoulder pain
  • Syncope
  • Dyspnea
  • Diaphoresis
  • Nausea

Differential Diagnosis

ST Elevation

Evaluation

  • EKG
  • Labs
  • Echocardiography
  • Cardiology consultation
  • Diagnosis made at time of coronary angiography

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.
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