Spontaneous primary dissection of the coronary artery

A 41 year old woman died suddenly and unexpectedly as a result of a spontaneous primary dissection of a coronary artery. This rare condition occurs typically in pre-menopausal women often in the peripartum period and hormonal changes have been among several suggested aetiological factors. In this case an association with auto-immune thyroiditis is described for the first time and the importance of extensive examination of the coronary arteries at autopsy is emphasised as the lesion was confined to a small focus near the apex of the heart.