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A 43 year old woman was admitted with sudden onset crushing central chest pain. She did not have any risk factors for ischaemic heart disease. An ECG revealed deep T wave inversion in the anterior leads with elevation of troponin I. Urgent coronary angiography revealed a 2 cm occlusive dissection flap in the mid left anterior descending artery (left panel, arrow; 1, left anterior descending artery; 2, circumflex artery) with distal TIMI (thrombolysis in myocardial infarction) grade 1 flow. The patient was successfully treated with angioplasty and four stents, which achieved a TIMI grade 3 flow (right panel; 1, left anterior descending artery, 2 circumflex artery). She remained very well at four month follow up with no recurrence of angina.
Spontaneous coronary artery dissection is an uncommon cause of acute coronary syndromes. It is a condition with greater prevalence in young women particularly in the peripartum period. Because of the rarity of this condition pathophysiologic characteristics, prognosis, and treatment remain unclear. Spontaneous coronary artery dissection should be considered in young patients with no apparent risk factors who present with acute coronary syndrome. Urgent coronary angiography should be considered to make a prompt diagnosis. We believe that interventional procedures may be the treatment of choice in patients with this condition.