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"Spontaneous" coronary artery dissection. The challenge of detection, the enigma of cause
J Wisecarver1, J Jones, T Goaley
1Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha 68105.
Insights
Sudden death from coronary artery dissection is rare, particularly in women. This case highlights the importance of family history in diagnosing this condition.
Area of Science:
- Cardiovascular Pathology
- Medical Genetics
Background:
- Sudden death from acute coronary artery dissection is uncommon but increasingly recognized.
- This condition is more prevalent in women and linked to postpartum deaths.
- Histological findings often include eosinophilic infiltration and cystic medial necrosis.
Observation:
- A case of sudden death in a 47-year-old woman was caused by dissection of the left anterior descending coronary artery.
- The coronary arteries showed cystic medial degeneration and glycosaminoglycan accumulation.
- Notably, no eosinophilic infiltrate was present in the arterial walls.
Findings:
- The autopsy revealed dissection of the distal left anterior descending coronary artery.
- Microscopic examination showed cystic medial degeneration and significant glycosaminoglycan deposition.
- Absence of eosinophilic infiltrate distinguished this case from typical reports.
Implications:
- This case underscores the need for thorough investigation of coronary artery dissection, even without typical histological findings.
- A positive family history of aneurysms in this case suggests a potential genetic predisposition.
- Comprehensive family history is crucial for identifying individuals at risk for arterial dissection and aneurysms.
Abstract:
Sudden death secondary to acute dissection of a coronary artery is a rare, but increasingly recognized, cause of sudden, unexpected death in apparently healthy persons. It has been reported more frequently in women and has been associated with sudden death during the puerperium. It has also been reported that these involved coronary vessels contain increased numbers of eosinophils and often show areas of cystic medial necrosis. In this article, we report a case of sudden death in a 47-year-old white woman due to dissection of the distal segment of her left anterior descending coronary artery. There was marked involvement of the coronary arterial walls with cystic degeneration of the media with accumulation of glycosaminoglycans as demonstrated by Alcian blue staining. There was no eosinophilic infiltrate within the arterial walls. This case is unusual in that this woman's mother and brother both have had aneurysms, which stresses the importance of not only searching carefully for these lesions, but also of obtaining family history in such cases.