Spontaneous coronary artery dissection related to menstruation

We present the case of a young woman who developed an acute onset of classic cardiac symptoms, but because of her age and lack of risk factors, had a significant delay in transfer for cardiac catheterization. She was found to have spontaneous dissection of the left coronary system, eventually requiring emergent bypass surgery. The patient had recently began her menstrual period, and we speculate that hormonal fluctuations contributed to this process. The role of hormonal influences on the coronary vasculature is not entirely understood, but the incidence of spontaneous coronary dissection is higher in women, and is usually related to changes in hormones such as pregnancy and oral contraceptive use. We review the literature on spontaneous coronary dissection, the influence of hormones on the vasculature, as well as diagnosis and treatment options.