[Spontaneous coronary artery dissection: apropos of a case with associated spasm and regression of the dissection]

Abstract

The authors report the case of a 34 year old woman with postpartum myocardial infarction due to spontaneous coronary dissection of the distal circumflex artery. A spontaneously regressive spasm of the right coronary artery was also observed. The outcome with heparin, glyceryl trinitrate and calcium antagonist therapy was favourable. Over one year later, coronary angiography showed total resolution of the dissection and a large aneurysm of the inferior and septal walls of the left ventricle. This case is an example of post-partum spontaneous coronary dissection, in a particular vascular context. There are, however, other causes of spontaneous coronary artery dissection (atherosclerosis, eosinophilic syndrome...). Spasm may aggravate the consequences of coronary artery dissection and cause worse myocardial damage. The medical treatment, especially with regards to thrombolytic therapy, requires further codification.