Sudden cardiac death: coronary artery spontaneous dissection

Spontaneous coronary artery dissection (SCAD) is a rare pathology that can result in acute coronary syndrome and sudden cardiac death.1,2 Many cases have been reported since Pretty described SCAD for the first time in 1931 at the autopsy of a 42year old women who had suffered chest pain.3 The actual incidence is thought to be higher as majority of cases is diagnosed at autopsy. The causes of SCAD are classified into 3 main subgroups: atherosclerotic disease, peripartum period, and idiopathic. It has been suggested that oral contraceptive use, cocaine use, blunt chest trauma, Marfan syndrome, cystic medial necrosis, hypersensitivity vasculitis and heavy exercise may be associated with SCAD.4,5 There was no underlying cause in our case and it was evaluated as idiopathic. Patients with SCAD can present with heart attacks, cardiac arrest, or sudden cardiac death. Symptoms of heart attacks in these cases can include chest, shoulder, arm, or epigastric pain, with or without shortness of breath and nausea/ vomiting. The heart attack severity can range from mild to severe, which may compromise heart function, causing heart failure, low blood pressure, and other organ dysfunction. During hospitalization, heart enzymes and electrocardiograms often show changes consistent with heart attacks. Some may even have abnormal heart rhythms, causing cardiac arrest that can be lethal. In this study, it is aimed to present a case of spontaneous coronary artery dissection that result in sudden death.