Spontaneous Coronary Artery Dissection

A 45-year-old female athlete with no history of cardiovascular disease or coronary risk factors presented with a non-ST-segment elevation myocardial infarction due to spontaneous right coronary artery dissection. She was treated medically with resolution of her symptoms. Repeat angiography due to recurrent exertional chest discomfort showed TIMI-3 flow and no evidence of dissection. Intravascular ultrasound documented discrete areas of resolving hematoma, but no dissection flap or impingement of the lumen >30%. A coronary computed tomography 6 months later revealed absence of any vascular abnormalities. This rare but potentially lethal condition should be considered in the differential diagnosis of young patients with chest pain, myocardial infarction, or sudden cardiac death, especially if it involves women either in the peripartum period or those using oral contraceptives, or patients without evidence of coronary atherosclerosis or traditional cardiovascular risk factors.