Skip to main content
PMC home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2006 Dec 5;27(7):377–380. doi: 10.1002/clc.4960270702

Spontaneous coronary artery dissection

Francis Q Almeda 1,✉, Sameer Barkatullah 1, Clifford J Kavinsky 1
PMCID: PMC6654176  PMID: 15298035

Abstract

Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute myocardial ischemia with complex pathophysiology. This paper reviews the major diagnostic and therapeutic issues of this rare but important disease. The diagnosis of SCAD should be strongly considered in any patient who presents with symptoms suggestive of acute myocardial ischemia, particularly in young subjects without traditional risk factors for coronary artery disease (especially in young women during the peripartum period or in association with oral contraceptive use). Urgent coronary angiography is indicated to establish the diagnosis and to determine the appropriate therapeutic approach. The decision to pursue medical management, percutaneous coronary intervention, or surgical revascularization is based primarily on the clinical presentation, extent of dissection, and amount of ischemic myocardium at risk.

Keywords: coronary vessel, coronary artery disease, dissection, myocardial ischemia, acute coronary syndrome, spontaneous coronary artery dissection, peripartum complication

Full Text

The Full Text of this article is available as a PDF (50.0 KB).

References

  • 1. Zampieri P, Aggio S, Roncon L, Rinuncini M, Canova C, Zanazzi G, Fiorencis R, Zonzin P: Follow up after spontaneous coronary artery dissection: A report of five cases. Heart 1996; 75: 206–209 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2. Cohen DE, Strimike CL: A case of multiple spontaneous coronary artery dissections. Cathet Cardiovasc Interv 2000; 49: 318–320 [DOI] [PubMed] [Google Scholar]
  • 3. Wellford LA, Kelly TM: Survival with acute primary coronary artery dissection: A case report and review of the literature. J Emerg Med 1994; 12: 193–198 [PubMed] [Google Scholar]
  • 4. Basso C, Morgagni GL, Thiene G: Spontaneous coronary artery dissection: A neglected cause of acute myocardial ischaemia and sudden death. Heart 1996; 75: 451–454 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5. Adkins GF, Steele RH: Left coronary artery dissection: An unusual presentation. Br Heart J 1986; 55: 411–414 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6. Cheung A, Chan CW: Dissecting aneurysm of coronary artery presenting as cardiac tamponade. NZ Med J 1990; 103–886: 129–130 [PubMed] [Google Scholar]
  • 7. Shaver PJ, Carrig TF, Baker WP: Postpartum coronary artery dissection. Br Heart J 1978; 40: 83–86 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8. DeMaio SJ Jr, Kinsella SH, Silverman ME: Clinical course and long‐term prognosis of spontaneous coronary artery dissection. Am J Cardiol 1989; 64: 471–74 [DOI] [PubMed] [Google Scholar]
  • 9. Jorgensen MB, Aharonian V, Mansukhani P, Mahrer PR: Spontaneous coronary dissection: A cluster of cases with this rare finding. Am Heart J 1994; 127: 1382–1387 [DOI] [PubMed] [Google Scholar]
  • 10. Kearney P, Singh H, Hutter J, Khan S, Lee G, Lucey J: Spontaneous coronary artery dissection: A report of three cases and review of the literature. Postgrad Med J 1993; 69: 940–945 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11. Koul AK, Hollander G, Moskovits N, Frankel R, Herrera L, Shani J: Coronary artery dissection during pregnancy and the postpartum period: Two case reports and review of literature. Cathet Cardiovasc Interv 2001; 52: 88–94 [DOI] [PubMed] [Google Scholar]
  • 12. Pita JP, Gonzalez NV, Alvarez LP, Rodriguez JMV, Bieras AC: Spontaneous coronary artery dissection. Cathet Cadiovasc Diagn 1994; 32: 27–32 [DOI] [PubMed] [Google Scholar]
  • 13. Shah C, Narula D, Kulkarni H, Dalvi B: Spontaneous coronary artery dissection in a young man with inferior wall myocardial infarction. Am Heart J 1996; 132: 696–698 [DOI] [PubMed] [Google Scholar]
  • 14. Sage MD, Koelmeyer TD, Smeeton WM: Fatal postpartum coronary artery dissection. A light‐ and electron‐ microscope study. Am J Forens Med Pathol 1986; 7: 107–111 [DOI] [PubMed] [Google Scholar]
  • 15. Parry R, MacConnell T, Wilde P: Case report: Spontaneous coronary artery dissection. Clin Radiol 1994; 49: 142–143 [DOI] [PubMed] [Google Scholar]
  • 16. Nalbandian RM, Chason JL: Intramural [intramedial] dissecting haematomas in normal or otherwise unremarkable coronary arteries: A “rare” cause of death. Am J Clin Pathol 1965; 43: 348–356 [DOI] [PubMed] [Google Scholar]
  • 17. Bulkley BH, Roberts WC: Dissecting aneurysm [hematoma] limited to coronary artery. A clinicopathologic study of six patients. Am J Med 1973; 55: 747–756 [DOI] [PubMed] [Google Scholar]
  • 18. Bateman AC, Gallagher PJ, Vincenti AC: Sudden death from coronary artery dissection. J Clin Pathol 1995; 48: 781–784 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. Iskandrian AS, Bemis CE, Kimbiris D, Mintz GS, Hakki AH: Primary coronary artery dissection. Chest 1985; 87: 227–228 [DOI] [PubMed] [Google Scholar]
  • 20. Singh RS, Pannu HS, Agarwal R, Prasad VS, Cherian KM: Spontaneous double vessel coronary artery dissection: A case report and surgical management. Scand Cardiovasc J 1997; 31: 181–183 [DOI] [PubMed] [Google Scholar]
  • 21. Atay Y, Yagdi T, Turkoglu C, Altintig A, Buket S: Spontaneous dissection of the left main coronary artery: A case report and review of the literature. J Cardiol Surg 1996; 11: 371–375 [DOI] [PubMed] [Google Scholar]
  • 22. Madu EC, Kosinski DJ, Wilson WR, Burket MW, Fraker TD Jr, Ansel GM: Two‐vessel coronary artery dissection in the peripartum period. Case report and literature review. Angiology 1994; 45: 809–816 [DOI] [PubMed] [Google Scholar]
  • 23. Mather PJ, Hansen CL, Goldman B, Inniss S, Pina I, Norris R, Jeevanandam V, Bove AA: Postpartum multivessel coronary dissection. J Heart Lung Transplant 1994; 13: 533–537 [PubMed] [Google Scholar]
  • 24. Emori T, Goto Y, Maeda T, Chiba Y, Haze K: Multiple coronary artery dissections diagnosed in vivo in a pregnant woman. Chest 1993; 104: 289–290 [DOI] [PubMed] [Google Scholar]
  • 25. Tsimikas S, Giordano FJ, Tarazi RY, Beyer RW: Spontaneous coronary artery dissection in patients with renal transplantation. J Invas Cardiol 1999; 11: 316–321 [PubMed] [Google Scholar]
  • 26. Virmany R, Forman MB, Rabinowitz M, McAllister HA: Coronary artery dissections. Cardiol Clin 1984; 4: 633–646 [PubMed] [Google Scholar]
  • 27. Bac DJ, Lotgering FK, Verkaaik AP, Deckers JW: Spontaneous coronary artery dissection during pregnancy and post partum. Eur Heart J 1995; 16: 136–138 [DOI] [PubMed] [Google Scholar]
  • 28. Azam MN, Roberts DH, Logan WF: Spontaneous coronary artery dissection associated with oral contraceptive use. Int J Cardiol 1995; 48: 195–198 [DOI] [PubMed] [Google Scholar]
  • 29. Lees MM, Taylor SH, Scott DB, Kerr MG: A study of cardiac output at rest throughout pregnancy. J Obstet Gynaecol Br Commonw 1967; 74: 319–328 [DOI] [PubMed] [Google Scholar]
  • 30. Scott DE, Pritchard JA: Anemia in pregnancy. Clin Perinatol 1974; 2: 491–506 [PubMed] [Google Scholar]
  • 31. Walters WAW, MacGregor WG, Hills M: Cardiac output at rest during pregnancy and the puerperium. Clin Sci 1966; 30: 1 [PubMed] [Google Scholar]
  • 32. Pyorola T: Cardiovascular response to upright position during pregnancy. Acta Obstet Gynaecol Scand 1966; 45: 8 [DOI] [PubMed] [Google Scholar]
  • 33. Brehm H, Kindling E: Der Kreislauf während Schwangerschaft und Wochenbett. Arch Gynaecol 1955; 185: 696 [DOI] [PubMed] [Google Scholar]
  • 34. Klutstein MW, Tzivoni D, Bitran D, Mendzelevski B, Ilan M, Almagor Y: Treatment of spontaneous coronary artery dissection: Report of three cases. Cathet Cardiovasc Diagn 1997; 40: 372–376 [DOI] [PubMed] [Google Scholar]
  • 35. Manallo‐Estrella P, Barker AB: Histopathological findings in human aortic media associated with pregnancy. Arch Pathol Lab Med 1967; 83: 336–341 [PubMed] [Google Scholar]
  • 36. Asuncion CM, Hyun J: Dissecting intramural hematoma of the coronary artery in pregnancy and the puerperium. Obstet Gynecol 1972; 40: 202–210 [PubMed] [Google Scholar]
  • 37. Barrett JM, Van Hooydonk JE, Boehm FH: Pregnancy‐related rupture of arterial aneurysms. Obstet Gynecol Surv 1982; 37: 557–566 [DOI] [PubMed] [Google Scholar]
  • 38. Corrado D, Thiene G, Cocco P, Frescura C: Non‐atherosclerotic coronary artery disease and sudden death in the young. Br Heart J 1992; 68: 601–607 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39. Hunsaker JC III, O'Connor WN, Lie JT: Spontaneous coronary arterial dissection and isolated eosinophilic coronary arteritis: Sudden cardiac death in a patient with a limited variant of Churg‐Strauss syndrome. Mayo Clin Proc 1992; 67: 761–766 [DOI] [PubMed] [Google Scholar]
  • 40. Dowling GP, Buja LM: Spontaneous coronary artery dissection occurs with and without periadventitial inflammation. Arch Pathol Lab Med 1987; 111: 470–472 [PubMed] [Google Scholar]
  • 41. Robinowitz M, Virmani R, McAllister HAJ: Spontaneous coronary artery dissection and eosinophilic inflammation: A cause and effect relationship? Am J Med 1982; 72: 923–928 [DOI] [PubMed] [Google Scholar]
  • 42. Huikuri HV, Mallon SM, Myerburg RJ: Cardiac arrest due to spontaneous coronary artery dissection in a patient with coronary ectasia—a case report. Angiology 1991; 42: 148–151 [DOI] [PubMed] [Google Scholar]
  • 43. Borczuk AC, van Hoeven KH, Factor SM: Review and hypothesis: The eosinophil and peripartum heart disease (myocarditis and coronary artery dissection)—coincidence or pathogenetic significance? Cardiovasc Res 1997; 33: 527–532 [DOI] [PubMed] [Google Scholar]
  • 44. Koller PT, Cliffe CM, Ridley DJ: Immunosuppressive therapy for peripartum‐type spontaneous coronary artery dissection: Case report and review. Clin Cardiol 1998; 21: 40–46 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45. Palomino SJ: Dissecting intramural hematoma of left coronary artery in the puerperium: A case report and survey of the literature. Am J Clin Pathol 1969; 51: 119–125 [DOI] [PubMed] [Google Scholar]
  • 46. Ciraulo DA, Chesne RB: Coronary arterial dissection: An unrecognized cause of myocardial infarction, with subsequent coronary arterial patency. Chest 1978; 73: 677–679 [DOI] [PubMed] [Google Scholar]
  • 47. Thayer JO, Healy RW, Maggs PR: Spontaneous coronary artery dissection. Ann Thorac Surg 1987; 44: 97–102 [DOI] [PubMed] [Google Scholar]
  • 48. Aldoboni AH, Majdi K, Ngibzadhe M, Palasaidi S, Moayed DA: Spontaneous dissection of coronary artery treated by primary stenting as the first presentation of systemic lupus erythematosus. J Invas Cardiol 2002; 14: 694–696 [PubMed] [Google Scholar]
  • 49. Saunders SL, Ford SE: Primary coronary artery dissection possibly related to drug hypersensitivity in a male. Can J Cardiol 1991; 7: 138–140 [PubMed] [Google Scholar]
  • 50. Kerwin TC, Klein LW: Spontaneous coronary artery dissection following low‐intensity blunt chest trauma: A case report and review of current treatment options. J Invas Cardiol 2002; 14: 679–681 [PubMed] [Google Scholar]
  • 51. Cheung S, Mithani V, Watson RM: Healing of spontaneous coronary dissection in the context of glycoprotein IIB/IIIA inhibitor therapy: A case report. Cathet Cardiovasc Interv 2000; 51: 95–100 [DOI] [PubMed] [Google Scholar]
  • 52. Mulvany NJ, Ranson DL, Pilbeam MC: Isolated dissection of the coronary artery: A postmortem study of seven cases. Pathology 2001; 33: 307–311 [PubMed] [Google Scholar]
  • 53. Masuda T, Akiyama H, Kurosawa T, Ohwada T: Long‐term follow‐up of coronary artery dissection due to blunt chest trauma with spontaneous healing in a young woman. Intens Care Med 1996; 22: 450–452 [DOI] [PubMed] [Google Scholar]
  • 54. Almahmeed WA, Haykowski M, Boone J, Ling H, Allard M, Webb J, Carere R: Spontaneous coronary artery dissection in young women. Cathet Cardiovasc Diagn 1996; 37: 201–205 [DOI] [PubMed] [Google Scholar]
  • 55. Ellis CJ, Haywood GA, Monro JL: Spontaneous coronary artery dissection in a young woman resulting from an intense gymnasium “work‐out.” Int J Cardiol 1994; 47: 193–194 [DOI] [PubMed] [Google Scholar]
  • 56. Sherrid MV, Mieres J, Mogtader A, Menezes N, Steinberg G: Onset during exercise of spontaneous coronary artery dissection and sudden death. Occurrence in a trained athlete: Case report and review of prior cases. Chest 1995; 108: 284–287 [DOI] [PubMed] [Google Scholar]
  • 57. Ehya H, Weitzner S: Postpartum dissecting aneurysm of coronary arteries in a patient with sarcoidosis. South Med J 1980; 73: 87–88 [DOI] [PubMed] [Google Scholar]
  • 58. Fournier JA, Lopez‐Pardo F, Fernandez‐Cortacero JA, Sanchez A: Spontaneous coronary artery dissection in mitral stenosis. Eur Heart J 1995; 16: 869–871 [DOI] [PubMed] [Google Scholar]
  • 59. Lie JT, Berg KK: Isolated fibromuscular dysplasia of the coronary arteries with spontaneous dissection and myocardial infarction. Hum Pathol 1987; 18: 654–656 [DOI] [PubMed] [Google Scholar]
  • 60. Jaffe BD, Broderick TM, Leier CV: Cocaine‐induced coronary‐artery dissection. N Engl J Med 1994; 330: 510–511 [DOI] [PubMed] [Google Scholar]
  • 61. Steinhauer JR, Caulfield JB: Spontaneous coronary artery dissection associated with cocaine use: A case report and brief review. Cardiovasc Pathol 2001; 10: 141–145 [DOI] [PubMed] [Google Scholar]
  • 62. Lee TM, Liau CS: Spontaneous coronary artery dissection in an elderly woman with acute inferior myocardial infarction. A case report. Angiology 1995; 46: 847–851 [DOI] [PubMed] [Google Scholar]
  • 63. Fernandez‐Gutierrez B, Zamorano J, Batlle E, Alfonso F, Conde A, Sanchez‐Harguindey L, Jover JA: Coronary dissection associated with hepatitis C virus‐related cryoglobulinaemia. Rheumatology (Oxford) 1999; 38: 1299–1301 [DOI] [PubMed] [Google Scholar]
  • 64. Judkins DA, Miller SJ, Capone RJ, Houghton JL: Spontaneous multivessel coronary artery dissection: Repeated presentation in a healthy postmenopausal woman. Clin Cardiol 1999; 22: 677–680 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 65. Antoniucci D, Magi Diligenti L: Spontaneous dissection of the three major coronary arteries. Eur Heart J 1990; 11: 1130–1134 [DOI] [PubMed] [Google Scholar]
  • 66. Tavella D, Turri M, Zardini P: Images in cardiology: Cardiac arrest caused by spontaneous left coronary artery dissection in a young woman. Heart 2001; 85: 52 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 67. Gutierrez FR, McKnight RC, Ludbrook PA, Gowda S, Tiefenbrunn AJ: The radiographic appearance of coronary artery dissection: A decision‐making dilemma. Cardiovasc Intervent Radiol 1984; 7: 65–70 [DOI] [PubMed] [Google Scholar]
  • 68. Nishikawa H, Nakanishi S, Nishiyama S, Nishimura S, Seki A, Yamaguchi H: Primary coronary artery dissection observed at coronary angiography. Am J Cardiol 1988; 61: 645–648 [DOI] [PubMed] [Google Scholar]
  • 69. Vale PR, Baron DW: Coronary artery stenting for spontaneous coronary artery dissection: A case report and review of the literature. Cathet Cardiovasc Diagn 1998; 45: 280–286 [DOI] [PubMed] [Google Scholar]
  • 70. Maehara A, Mintz GS, Castagna MT, Pichard AD, Satler LF, Waksman R, Suddath WO, Kent KM, Weissman NJ: Intravascular ultrasound assessment of spontaneous coronary artery dissection. Am J Cardiol 2002; 89: 466–468 [DOI] [PubMed] [Google Scholar]
  • 71. Choi JW: Spontaneous multivessel coronary artery dissection in a long‐distance runner successfully treated with oral antiplatelet therapy. J Invas Cardiol 2002; 14: 675–678 [PubMed] [Google Scholar]
  • 72. Buys EM, Suttorp MJ, Morshuis WJ, Plokker HW: Extension of a spontaneous coronary artery dissection due to thrombolytic therapy. Cathet Cardiovasc Diagn 1994; 33: 157–160 [DOI] [PubMed] [Google Scholar]
  • 73. Koga T, Sakamoto A, Nakamura Y, Kawazoe N, Sadoshima S, Onoyama K, Fujishima M: Circumferential spontaneous coronary artery dissection in an elderly man: A case report. Angiology 1998; 49: 83–86 [DOI] [PubMed] [Google Scholar]
  • 74. Gonzalez JI, Hill JA, Conti CR: Spontaneous coronary artery dissection treated with percutaneous transluminal angioplasty. Am J Cardiol 1989; 63: 885–886 [DOI] [PubMed] [Google Scholar]
  • 75. Giudici MC, Artis AK, Webel RR, Alpert MA: Postpartum myocardial infarction treated with percutaneous transluminal coronary angioplasty. Am Heart J 1989; 118: 614–616 [DOI] [PubMed] [Google Scholar]
  • 76. Mafrici A, Cioffi P, Alberti A: Spontaneous coronary dissection as a cause of acute myocardial infarct: Description of a case and review of the literature. G Ital Cardiol 1997; 27: 821–826 [PubMed] [Google Scholar]
  • 77. Hering D, Piper C, Hohmann C, Schultheiss HP, Horstkotte D: Prospective study of the incidence, pathogenesis and therapy of spontaneous, by coronary angiography diagnosed coronary artery dissection. Z Kardiol 1998; 87: 961–970 [DOI] [PubMed] [Google Scholar]
  • 78. Cowan NC, de Belder MA, Rothman MT: Coronary angioplasty in pregnancy. Br Heart J 1988; 59: 588–592 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 79. Bergelson BA, Fishman RF, Tommaso CL: Abrupt vessel closure: Changing importance, management, and consequences. Am Heart J 1997; 134: 362–381 [DOI] [PubMed] [Google Scholar]
  • 80. Fish RD: A 37‐year‐old woman with angina pectoris. Circulation 1994; 89: 898–908 [DOI] [PubMed] [Google Scholar]
  • 81. Thistlethwaite PA, Tarazi RY, Giordano FJ, J Amieson SW: Surgical management of spontaneous left main coronary artery dissection. Ann Thorac Surg 1998; 66: 258–260 [DOI] [PubMed] [Google Scholar]
  • 82. Vicari R, Eybel C, Monson D: Survival following spontaneous coronary artery dissection: Surgical repair by extrusion of intramural hematoma. Am Heart J 1986; 111: 593–594 [DOI] [PubMed] [Google Scholar]
  • 83. Keon WJ, Koshal A, Boyd WD, Laramee L, Farrell E, Walley VM: Survival after spontaneous primary left main coronary artery dissection. Acute surgical intervention with the Jarvik 7‐70 artificial heart. J Cardiovasc Surg (Torino) 1989; 30: 786–789 [PubMed] [Google Scholar]
  • 84. Curiel P, Spinelli G, Petrella A, Gori A, De Maria R, Bonacina E, Gronda E: Postpartum coronary artery dissection followed by heart transplantation. Am J Obstet Gynecol 1990; 163: 538–539 [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES