Forensic Science, Medicine, and Pathology

, Volume 13, Issue 2, pp 248–251 | Cite as

Spontaneous coronary artery dissection

  • Roger W. ByardEmail author
  • John D Gilbert
  • Neil E. I. Langlois
Images in Forensics

Case reports

Case 1

A 35-year-old previously well woman was found dead in bed. She had a past history of vitamin B12 deficiency, headaches and neck pain associated with degenerative changes at the C5/6 level. She was on no medications and had not used oral contraceptives for 4 years. She had recently lost 14 kg in weight and had been attending a gymnasium five nights a week. She was not pregnant or postpartum.

At autopsy the major findings were limited to the heart where there was a dissection of the left coronary artery system involving the left main stem artery, the proximal 25 mm of the left anterior descending artery (Fig. 1) and the proximal 5 mm of the left circumflex artery. The dissection did not involve the aorta. There was no cardiac tamponade.


Compliance with ethical standards

Ethical approval

This article does not contain any studies with human participants performed by any of the authors. Approval to report these cases was given by Forensic Science SA, Adelaide Australia.


This study was not funded.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Lipsett J, Byard RW, Carpenter BF, Jimenez CL, Bourne AJ. Anomalous coronary arteries arising from the aorta associated with sudden death in infancy and early childhood. Arch Pathol Lab Med. 1991;115:770–3.PubMedGoogle Scholar
  2. 2.
    Walley VM, Byard RW, Keon WJ. A study of the sequential morphologic changes after manual coronary endarterectomy. J Thorac Cardiovasc Surg. 1991;102:890–4.PubMedGoogle Scholar
  3. 3.
    Kanaroglou S, Nair V, Fernandes JR. Sudden cardiac death due to coronary artery dissection as a complication of cardiac sarcoidosis. Cardiovasc Pathol. 2015;24:244–6.CrossRefGoogle Scholar
  4. 4.
    D’Ovidio C, Sablone S, Carnevale A. Spontaneous coronary artery dissection: case report and literature review. J Forensic Sci. 2015;60:801–6.CrossRefGoogle Scholar
  5. 5.
    Yiangou K, Papadopoulos K, Azina C. Heavy lifting causing spontaneous coronary artery dissection with anterior myocardial infarction in a 54-year-old woman. Tex Heart Inst J. 2016;43:189–91.CrossRefGoogle Scholar
  6. 6.
    Makino Y, Inokuchi G, Yokata H, Hayakawa M, Yajima D, Motomura A, et al. Sudden death due to coronary artery dissection associated with fibromuscular dysplasia revealed by post-mortem selective computed tomography coronary angiography: a case report. Forensic Sci Int. 2015;253:e10–5.CrossRefGoogle Scholar
  7. 7.
    Rogers IS, Rinaldi MJ, Humphrey CB, Boden WE, Dougherty JE. Postpartum dissection of the left main coronary artery. Clin Cardiol. 2006;29:175–8.CrossRefGoogle Scholar
  8. 8.
    Saw J, Mancini J, Humphries KH. Contemporary review on spontaneous coronary artery dissection. J Am Coll Cardiol. 2016;68:297–312.CrossRefGoogle Scholar
  9. 9.
    Barbesier M, Boval C, Desfeux J, Lebreton C, Léonetti G, Piercecchi-Marti M-D. Acute fatal coronary artery dissection following exercise-related blunt chest trauma. J Forensic Sci. 2015;60:233–5.CrossRefGoogle Scholar
  10. 10.
    Maeder M, Ammann P, Angehrn W, Rickli H. Idiopathic spontaneous coronary artery dissection: incidence, diagnosis and treatment. Int J Cardiol. 2005;101:363–9.CrossRefGoogle Scholar
  11. 11.
    Dobiáš M, Hejna P, Mawiri AA. Coronary artery dissection: a fatal complication following blunt chest trauma. Forensic Sci Med Pathol. 2013;9:454–7.CrossRefGoogle Scholar
  12. 12.
    Tweet MS, Gulati R, Hayes SN. Spontaneous coronary artery dissection. Curr Cardiol Rep. 2016;18:60.CrossRefGoogle Scholar
  13. 13.
    Saw J. Spontaneous coronary artery dissection. Can J Cardiol. 2013;29:1027–33.CrossRefGoogle Scholar
  14. 14.
    Yip A, Saw J. Spontaneous coronary artery dissection - a review. Cardiovasc Diagn Ther. 2015;5:37–48.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Papireddy MR, Nabdish S, Mishkel GJ. Recurrent spontaneous coronary artery dissection: first case report in men with three episodes of spontaneous coronary dissection in separate vascular territories. Catheter Cardiovasc Interv. 2016;87:E192–6.CrossRefGoogle Scholar
  16. 16.
    Tsutsui H, Chino C, Komatsu M, Sakai T, Aizawa K, Owa M. Resolution of spontaneous coronary artery dissection within 3 weeks detected by computed tomography angiography and intravascular untrasound. Cardiovasc Interv Ther. 2017;32(1):77–81.CrossRefGoogle Scholar
  17. 17.
    Alfonso F, Bastante T, Cuesta J, Rodriguez D, Benedicto A, Rivero F. Spontaneous coronary artery dissection: novel insights on diagnosis and management. Cardiovasc Diagn Ther. 2015;5:133–40.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Roth A, Elkayam U. Acute myocardial infarction associated with pregnancy. J Am Coll Cardiol. 2008;52:171–80.CrossRefGoogle Scholar
  19. 19.
    Manalo-Estrella P, Barker AE. Histopathologic findings in human aortic media associated with pregnancy. Arch Pathol. 1967;83:336–41.PubMedGoogle Scholar
  20. 20.
    Herbst J, Winskog C, Byard RW. Cardiovascular conditions and the evaluation of the heart in pregnancy-associated autopsies. J Forensic Sci. 2010;55:1528–33.CrossRefGoogle Scholar
  21. 21.
    Mandel R, Brooks EG, Corliss RF. Eosinophilic coronary periarteritis with arterial dissection: the mast cell hypothesis. J Forensic Sci. 2015;60:1088–92.CrossRefGoogle Scholar
  22. 22.
    Alfonso F, Bastante T, Rivero F, Cuesta J, Benedicto A, Saw J, et al. Spontaneous coronary artery dissection – from diagnosis to management. Circ J. 2014;78:2099–110.CrossRefGoogle Scholar
  23. 23.
    Desai S, Sheppard MN. Sudden cardiac death – look closely at the coronaries for spontaneous dissection which can be missed. A study of 9 cases. Am J Forensic Med Pathol. 2012;33:26–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Roger W. Byard
    • 1
    • 2
    • 3
    Email author
  • John D Gilbert
    • 1
    • 2
  • Neil E. I. Langlois
    • 1
    • 2
  1. 1.School of MedicineThe University of AdelaideAdelaideAustralia
  2. 2.Forensic ScienceAdelaideAustralia
  3. 3.Discipline of Anatomy and PathologyThe University of AdelaideAdelaideAustralia

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