Research Day

Coronary Artery Dissection Associated With Ascending Aortic Dissection

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INTRODUCTION: Coronary artery dissection is a rare cause of acute MI - occurring more commonly in women and young patients.

PURPOSE: We present a case of an ascending thoracic aortic dissection with associated left coronary artery dissection and complete lumen compression.

MATERIALS: This case is selected from the files of one of the authors (JP).

CASE REPORT: A 36-year-old male, who was reportedly kicked by a cow one day prior, complained of new onset epigastric pain, left arm pain, and eventually became unresponsive. Autopsy revealed a 3cm partial-thickness intimal tear of the proximal ascending thoracic aorta. The aorta was free of atherosclerosis. An associated left coronary artery (LCA) dissection was contiguous with the aortic dissection, with complete compression of the LCA, as well as the proximal left circumflex and left anterior descending arteries. The myocardium of the anterior left ventricle showed subtle mottling. Postmortem toxicology showed acetaminophen in the urine. There was no evidence of musculoskeletal trauma. The cause of death was coronary artery dissection related to an ascending thoracic aortic dissection. The manner of death was natural.

DISCUSSION: Trauma and atherosclerosis are recognized as common causes of aortic dissection. Despite recent trauma, definite correlation could not be proven. When encountered by an arterial dissection, physicians should be aware of possible predisposing conditions, including fibromuscular dysplasia, inflammatory processes, and connective tissue disorders. In this case, fibroblast cultures were obtained at the request of surviving family members and submitted for evaluation for heritable connective tissue disorders.

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