Extensive intramural hematoma and coronary artery dissection

Abstract

A 42-year-old lady presented to emergency department with sudden onset of chest pain. She was not pregnant. She was treated for an acute coronary syndrome with aspirin, clopidogrel and intravenous heparin. On day 3 of her admission, with further angina and an elevated troponin, she underwent coronary angiography. Her left anterior descending (LAD) artery showed evidence of a dissection with a ‘step down’ proximally (Fig. A, arrow) and two consecutive occluded diagonal branches (Fig. A, bracket).