Multiple spontaneous coronary artery dissections in a middle aged woman: support for an underlying eosinophilic arteritis predisposing to intimal disruption.

A 43-year-old female received tissue plasminogen activator for an acute antero-apical myocardial infarction. Cardiac catheterization demonstrated three focal dissections involving the left anterior descending and circumflex arteries. She expired unexpectantly after undergoing emergency coronary artery bypass grafting for therapy of an extension of her infarct. To our knowledge, this is the fourth report of multiple spontaneous coronary artery dissections and the second in which tissue plasminogen activator was administered. The histologic findings and their implications are reviewed.