Primary spontaneous coronary artery dissection (SCAD) is a rare but potentially life-threatening condition.
(1) usually a young woman but a quarter may be male
(2) pregnancy, early postpartum period or use of oral contraceptives
(3) absence of the usual risk factors associated with coronary artery disease and the patient may be physically active
(4) precordial chest pain or other manifestation of an acute coronary event
(5) exclusion of other diagnoses (cocaine abuse, methampheatmine abuse, antiphospholipid syndrome, vasculitis)
The diagnosis can now be made using advanced imaging to demonstrate a dissection in the coronary arteries.
The pathology shows:
(1) adventitial eosinophilic inflammation
(2) dissection of the coronary artery in the layers of the media or between the media and the adventitia
If a single, localized lesion is identified, then aggressive management (coronary artery bypass graft, stent placement) has been associated with a better outcome.
If the patient survives the acute event then the prognosis is often favorable.
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