Spontaneous coronary artery dissection in a healthy postmenopausal woman

Spontaneous coronary artery dissection (SCAD) is rare and when it occurs is most commonly seen in young females following childbirth. We report a case of a 55-year-old female who was found dead at her home. She had no history of cardiovascular disease. She smoked approximately 10 cigarettes per day. She complained of mild chest discomfort the night before her death, lasting for 10 minutes, for which no medical attention was sought. She had been seen and appeared well 15 minutes before death. At autopsy, the only abnormality was in the left anterior descending coronary artery, which showed a two cm segment with periluminal blood in the wall of the vessel compressing the lumen. Histologically, a dissection was seen between the media and the external elastic lamina of the affected artery. There was a mixed inflammatory infiltrate including eosinophils and very occasional giant cells. Alcian blue staining was negative. The appearances were those of a localised dissection. The remaining coronary arteries were free of atheroma. SCAD should be suspected in young females in their postpartum period presenting with chest pain since emergency treatment can greatly increase survival.