[Isolated spontaneous coronary dissection]

Spontaneous coronary artery dissection is a rare cause of myocardial infarction. It occurs most commonly in young, otherwise healthy women, especially in the peripartum period. Dissections are most often located in the proximal part of the left coronary artery. Histologically a hematoma is found in the media with compression of the true lumen and usually a localized periadventitial inflammation. The etiology of the disease is unknown; hormonal influences and defective collagen metabolism are discussed. Prognosis is poor; only one third of patients survive the first 24 hours after acute onset of symptoms, and mortality is high in the following days and weeks. Surgery may prevent extension of infarction, and for this reason early diagnosis by coronary angiography is essential in patients at risk for this disease. Two cases of coronary dissection are described, followed by a review of the literature and discussion of etiology, prognosis and management.