Figure 1.
Imaging and Pathologic Evidence for AMCAD
(A) Unifying entity of SICM and pathways to recovery or AMCAD. Greyed boxes for theoretical AMCAD link to plaque rupture, although limited direct observations to support. (B to D) Case example of 74-year-old female admitted with ACS after emotional stress: left ventricle angiogram (B) demonstrating classic appearance of mid-ventricular SICM with hyperkinesis of the apex and base (arrows) and akinesis/dyskinesis in the mid-ventricle in systole. Coronary angiogram (C) showing co-existent 2-vessel SCAD (arrows). Caliber change in mid LAD representing intramural hematoma as identified on optical coherence tomography (inset, asterisk). Contrast staining of short segment intimal dissection plane in branch of ramus. Magnetic resonance imaging short axis, strain and strain rate (D) as described in text. (E) Hematoxylin and eosin cross-section of mid LAD SCAD indicating blood in outer media and separation of media from adventitia in a 52-year-old female with cardiac arrest following myocardial infarction. (F) Near-identical appearance in mid LAD from 58F unexpected death after blunt chest trauma. Image courtesy of Guillaume Gauchotte, with details of case and autopsy findings as previously described.3 ACS = acute coronary syndrome; AMCAD = Acute Mechano-Cardiac Coronary Artery Disruption; LAD = left anterior descending coronary artery; SCAD = spontaneous coronary artery dissection; SICM = stress-induced cardiomyopathy.