A 32-year-old woman with two children and no personal history of interest presented with sudden cardiac death.
The autopsy did not show relevant findings with a heart without macroscopic changes of interest.
Microscopic examination revealed dissection of the external third of the anterior descending coronary artery with a dissecting hematoma that caused displacement of the affected wall by contact with the opposite side of the artery, causing complete vascular occlusion.
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In the adventitia and adjacent subadventitial media layer, an inflammatory infiltrate consisting of eosinophilic polymorphonuclear leukocytes, some macrophages and neutrophils is observed.
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DIAGNOSIS:
Spontaneous dissection of the anterior descending coronary artery.
COMMENTS:
Spontaneous dissection of the coronary arteries accounts for about 0.5-0.7% of cases of sudden cardiac death in patients aged between 30 and 40 years.
Most of them are women who have sex or are in the postpartum period.
Clinically, it manifests as chest pain and electrocardiographic evidence of acute myocardial infarction.
The vast majority of spontaneous coronary artery dissections occur in the anterior descending artery and there are no atherosclerotic lesions or histopathological signs of cystic medial degeneration.
The role of the predominantly eosinophilic inflammatory infiltrate observed in the adventitia and the external third of the middle layer remains unknown.
It has been postulated that it can be a true arteritis with this infiltrate being the main responsible for the dissection.
However, it has also been considered as an inflammatory reaction secondary to rupture of the vascular wall.
