Coronary artery dissection as cause of sudden death

Spontaneous coronary dissection is a rare condition, more frequently appearing in young people and that may determine stable or instable angina, heart attack, cardiogenic shock or sudden death. Women are more affected than men, especially the ones in the peripartum period. The pathologic mechanism is not at all known but it seems that atherosclerosis, connective tissue conditions and the peri-delivery period have been associated with spontaneous coronary dissection. The anterior descending artery is more often the site of the lesion in women while in men it is the right coronary artery. Taking into consideration the localization, dissection extension and the associated pathology a more effective treatment can be ruled, such as coronary by-pass, PTCA, stenting and drug treatment. Thanks to the modern cardiology investigation possibilities, the number of survivors is rising. We present a case of spontaneous coronary dissection that was identified in the circumstances of a sudden death. A 38 years old man deceased suddenly on the street, apparently in perfect health condition. During autopsy a rupture of an atheromatous plaque located on the ascending aorta determined the dissection of the wall that further continued on the left main coronary artery and on the descendent coronary artery. The histopathologic examination mentioned a false lumen in the outer third of the media, hyperemia of the vasa vasorum and minimal coronary atherosclerosis.