Spontaneous coronary artery dissection: the clinical spectrum.

Spontaneous coronary artery dissection is a rare but increasingly reported cause of myocardial ischemia and sudden death. It is more commonly seen in younger age groups and has a predilection for postpartum women. The clinical spectrum of its presentation includes angina, myocardial infarction, cardiogenic shock, and death. No specific cardiac risk factors have been associated with its occurrence. In postpartum patients, it is presumed that dissection results from pregnancy-induced degeneration of collagen and the additional stresses of parturition. The sporadic nature of spontaneous coronary artery dissection has precluded the development of any consensus for a medical approach, and treatment is usually tailored to individual patient needs. A case of postpartum spiral dissection of the left anterior descending coronary artery with successful medical management is reported.