Right coronary artery occlusion after acute proximal dissection (hematoma)

A known hypertensive presented to the hospital with sudden onset of chest pain and shock. ECG, cardiac enzymes, aortogram and echocardiogram were normal. Hemodynamic monitoring and radionucleotide angiogram demonstrated a severely dyskinetic right ventricle. Autopsy revealed proximal aortic dissection with extramural compression of right coronary artery, resulting in right ventricular dysfunction.