Coronary artery dissection

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  • Usually presents as an Anterior MI with ST changes in anterior Precordial leads (V1-V3)


  • Hormonal changes in vessel wall (eg pregnancy, contraceptives)
  • Shear forces
  • Fibromuscular dysplasia
  • Underling connective tissue disorder

Clinical Features

  • Chest or shoulder pain
  • Syncope
  • Dyspnea
  • Diaphoresis
  • Nausea

Differential Diagnosis

ST Elevation


  • Diagnosis made at time of coronary angiography


  • Aspirin, β-blocker, and 1 year of clopidogrel[1]
  • PCI can be challenging given vessel wall fragility


See Also


  1. Saw J, Aymong E, Sedlak T, et al. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv 2014; 7:645.