Coronary artery dissection


Illustration showing coronary artery dissection with formation of a hematoma (purple) within the walls of the coronary artery.
  • Spontaneous tear in the intimal wall of a coronary artery leading to a false lumen and intramural hematoma, similar to aortic dissection
  • Much more common in young women


  • Hormonal changes in vessel wall (eg pregnancy, contraceptives)
  • Shear forces
  • Fibromuscular dysplasia
  • Underling connective tissue disorder
  • Iatrogenic (during coronary angiography)

Clinical Features

Differential Diagnosis

ST Elevation


ECG showing ST elevation in the antero-lateral leads in a patient with coronary artery dissection.


  • EKG
    • Usually presents as an Anterior MI with ST changes in anterior Precordial leads (V1-V3)
  • Basic labs, including troponin
  • Echocardiography


  • EKG usually shows an Anterior MI with ST changes in anterior Precordial leads (V1-V3)
  • Troponin may be elevated
  • Definitive diagnosis made at time of coronary angiography



  • Admit

See Also

External Links


  1. Saw J, Aymong E, Sedlak T, et al. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv 2014; 7:645.