Spontaneous coronary artery dissection: a diagnosis to consider in acute coronary syndromes.

Spontaneous coronary artery dissection is an extremely rare cause of acute coronary syndrome, with a reported angiographic incidence ranging between 0.1 and 1.1%. It mainly affects young patients, in particular women in the peripartum period or taking oral contraceptives, without possessing a definite relation with the classic risk factors for coronary artery disease. The left coronary artery system is the most frequently diseased, although the pattern of artery involvement is gender-based. Clinically, the presentation spectrum ranges from mild symptoms to sudden cardiac death. The major pathophysiologic processes underlying medial dissection are the presence of an intimal tear or the formation of an intramural hematoma. Several treatment modalities have been reported with varying success, although owing to the rarity of this condition, the optimal treatment options remain to be established.