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Sudden Cardiac Death: Look Closely at the Coronaries for Spontaneous Dissection Which Can Be Missed. A Study of 9 Cases

Desai, Saral MD, FRCPath*; Sheppard, Mary N. FRCPath*†

American Journal of Forensic Medicine & Pathology: March 2012 - Volume 33 - Issue 1 - p 26–29
doi: 10.1097/PAF.0b013e3181e29598
Original Articles

Abstract: Spontaneous coronary artery dissection is a rare cause of death seen largely in young women, with many cases occurring in the early postpartum period. Nine cases with this condition were examined from our histopathology records comprising 6 women and 3 men with an age range of 26 to 47 years. All deaths were sudden, and only one patient complained of chest pain and she was 8 weeks postpartum. All cases showed dissection macroscopically, though 4 of the 6 cases, which were sent for a second opinion, were described as having normal coronaries by the referring pathologists. One heart seemed to have postmortem coronary artery thrombus and dissection was difficult to discern on gross examination. All cases were examined histologically and confirmed acute dissection of the coronary arteries, with more than 2 arteries affected in 2 cases. Histologic features of myocardial ischemia/infarction were noted in 4 cases so the explanation for the sudden death in the other 4 cases remains a possible fatal arrhythmia. The macroscopic changes in the heart of acute coronary artery dissection can be difficult to detect and can be easily mistaken for postmortem clot or a thrombus overlying an atheromatous plaque. All such cases with thrombus in the arteries, even the normal-looking coronary arteries, in young adults should be examined microscopically for dissection.

From the *Department of Histopathology, Royal Brompton Hospital, London, United Kingdom; and †CRY Centre for Cardiac Pathology, National Heart and Lung Institute, Imperial College, London, United Kingdom.

Manuscript received June 10, 2009; accepted January 5, 2010.

The authors report no conflicts of interest.

Reprints: Saral Desai, MD, FRCPath, Royal Brompton Hospital, Sydney Street, London, UK SW3 6NP. E-mail: saraldesai@gmail.com.

© 2012 Lippincott Williams & Wilkins, Inc.