{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T08:00:18Z","timestamp":1781164818543,"version":"3.54.1"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"818","license":[{"start":{"date-parts":[[1993,12,1]],"date-time":"1993-12-01T00:00:00Z","timestamp":754704000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1993,12,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>We describe the clinical course of three patients who developed spontaneous coronary artery dissection. All patients were young women, one 9 weeks pregnant. All presented with chest pain; one died suddenly proving refractory to resuscitation, another developed unstable angina culminating in myocardial infarction, cardiogenic shock and death, and the third patient underwent coronary artery bypass grafting following diagnosis of a spontaneous coronary dissection of the left anterior descending artery at angiography. Pathological findings in the two fatal cases are reported.<\/jats:p>\n               <jats:p>This condition, although rare, is a prominent cause of ischaemic coronary events in young women, when it is frequently associated with pregnancy or the puerperium. Most patients die suddenly, but a clinical spectrum is seen including stable and unstable angina, myocardial infarction and cardiogenic shock. The left anterior descending artery is most frequently affected. The classical histological finding is that of a large haematoma occupying the outer third of the media resulting in complete compression of the true lumen.<\/jats:p>\n               <jats:p>The cause of spontaneous dissection remains unclear but theories of aetiology include a medial eosinophilic angiitis, pregnancy-induced degeneration of collagen in conjunction with the stresses of parturition, and rupture of the vasal vasorum.<\/jats:p>\n               <jats:p>The diagnosis must be considered when a patient presents with a suggestive clinical profile. Urgent angiography should be undertaken to establish the diagnosis and consideration given to the need for coronary artery bypass grafting, which has been successfully employed in a number of patients. The uneventful long-term survival of cases treated conservatively has been reported.<\/jats:p>","DOI":"10.1136\/pgmj.69.818.940","type":"journal-article","created":{"date-parts":[[2008,12,29]],"date-time":"2008-12-29T21:25:21Z","timestamp":1230585921000},"page":"940-945","source":"Crossref","is-referenced-by-count":65,"title":["Spontaneous coronary artery dissection: a report of three cases and review of the literature"],"prefix":"10.1093","volume":"69","author":[{"given":"Peter","family":"Kearney","sequence":"first","affiliation":[{"name":"Department of Cardiology, University College Cork, South Infirmary Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harsh","family":"Singh","sequence":"additional","affiliation":[{"name":"Bristol Royal Infirmary , Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Hutter","sequence":"additional","affiliation":[{"name":"Bristol Royal Infirmary , Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saleem","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University College Cork, South Infirmary Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University College Cork, South Infirmary Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Lucey","sequence":"additional","affiliation":[{"name":"Bon Secours Hospital , Cork, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[1993,12,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1002\/ccd.1810240310","article-title":"Spontaneous coronary artery dissection in a young man with anterior myocardial infarction","volume":"24","author":"Yeoh, J.; Choo, H.; Soo, C.; Lim, Y.; Yan, C.","year":"1991","unstructured":"Yeoh, J., Choo, H., Soo, C., Lim, Y. & Yan, C. Spontaneous coronary artery dissection in a young man with anterior myocardial infarction. Cathet Cardiovasc Diagn 1991, 24: 186-188.","journal-title":"Cathet Cardiovasc Diagn"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1002\/clc.4960140714","article-title":"Thrombolytic therapy in spontaneous coronary artery dissection","volume":"14","author":"Behnam, R.; Tillinghast, S.","year":"1991","unstructured":"Behnam, R. & Tillinghast, S. Thrombolytic therapy in spontaneous coronary artery dissection. Clin Cardiol 1991, 14: 611-614.","journal-title":"Clin Cardiol"},{"key":"ref_3","first-page":"138","article-title":"Primary coronary artery dissection possibly related to drug hypersensitivity in a male","volume":"7","author":"Saunders, S.; Ford, S.","year":"1991","unstructured":"Saunders, S. & Ford, S. Primary coronary artery dissection possibly related to drug hypersensitivity in a male. 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Can J Cardiol 1991, 7: 138-140.","journal-title":"Can J Cardiol"},{"issue":"7","key":"ref_18","first-page":"107","article-title":"Fatal postpartum coronary artery dissection. A light and electron microscope study","volume":"1986","author":"Sage, M.; Koelmeyer, T.; Smeeton, W.","unstructured":"Sage, M., Koelmeyer, T. & Smeeton, W. Fatal postpartum coronary artery dissection. A light and electron microscope study. Am J Forensic Med Path 1986, 7: 107-111.","journal-title":"Am J Forensic Med Path"},{"key":"ref_19","first-page":"470","article-title":"Spontaneous coronary artery dissection occurs with and without periadventitial inflammation","volume":"111","author":"Dowling, G.; Buja, L.","year":"1987","unstructured":"Dowling, G. & Buja, L. Spontaneous coronary artery dissection occurs with and without periadventitial inflammation. 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Obstet Gynecol Surv 1982, 37: 557-566.","journal-title":"Obstet Gynecol Surv"},{"issue":"7","key":"ref_24","first-page":"904","article-title":"Spontaneous coronary artery dissection: case report and evidence for a defect in collagen metabolism","volume":"1986","author":"Bonnet, J.; Aumailley, M.; Thomas, D.","unstructured":"Bonnet, J., Aumailley, M., Thomas, D. et al. Spontaneous coronary artery dissection: case report and evidence for a defect in collagen metabolism. Eur Heart J 1986, 7: 904-909.","journal-title":"Eur Heart J"},{"key":"ref_25","first-page":"117","article-title":"Dissection aneurysms of coronary arteries","volume":"99","author":"Smith, J.","year":"1975","unstructured":"Smith, J. Dissection aneurysms of coronary arteries. 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Z Kardiol 1990, 79: 32-36.","journal-title":"Z Kardiol"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1056\/NEJM198405033101814","article-title":"Intracoronary streptokinase for acute coronary artery dissection","volume":"310","author":"Vacek, J.; McKiernan, T.","year":"1984","unstructured":"Vacek, J. & McKiernan, T. Intracoronary streptokinase for acute coronary artery dissection. N Engl J Med 1984, 310: 1187.","journal-title":"N Engl J Med"},{"key":"ref_29","first-page":"243","article-title":"Spontaneous coronary artery dissection: a case report and a review of the literature","volume":"45","author":"Matsuura, A.; Yasuura, K.; Sawasaki, M.","year":"1992","unstructured":"Matsuura, A., Yasuura, K., Sawasaki, M. et al. Spontaneous coronary artery dissection: a case report and a review of the literature. Kyoba Geka 1992, 45: 243-246.","journal-title":"Kyoba Geka"},{"key":"ref_30","first-page":"\"885","article-title":"Spontaneous coronary artery dissection treated with percutaneous transluminal angioplasty","volume":"63","author":"Gonzales, J.; Hill, J.; Conti, C.","year":"1989","unstructured":"Gonzales, J., Hill, J. & Conti, C. Spontaneous coronary artery dissection treated with percutaneous transluminal angioplasty. Am J Cardiol 1989, 63: 885-886. Postgrad Med J (1993) 69, 945 -947 i) The Fellowship of Postgraduate Medicine, 1993","journal-title":"Am J Cardiol; -947 i) The Fellowship of Postgraduate Medicine"},{"key":"ref_31","article-title":"Haemorrhage from oesophageal varices in patients with portal hypertension remains a common and serious medical emergency associated with significant mortality and morbidity. Injection sclerotherapy is the most effective primary therapy for acute variceal bleeding. Pharmacotherapy and Correspondence and present address","volume-title":"London W12 ONN. Accepted","author":"Beales, I.L.P.; Sc., B.; P., M.R.C.; of Gastroenterology, Department; Hospital, Hammersmith; Road, Du Cane","year":"1993","unstructured":"Haemorrhage from oesophageal varices in patients with portal hypertension remains a common and serious medical emergency associated with significant mortality and morbidity. Injection sclerotherapy is the most effective primary therapy for acute variceal bleeding. Pharmacotherapy and Correspondence and present address: I.L.P. Beales, B.Sc., M.R.C.P., Department of Gastroenterology, Hammersmith Hospital, Du Cane Road, London W12 ONN. Accepted: 17 May 1993 balloon tamponade have useful supporting roles.\" 2 Despite therapy, some 10-20% of patients may continue bleeding35 and in these cases the prognosis is poor.3 We report a case of severe refractory bleeding in a patient with poor outlook, eventually controlled with a transjugular intrahepatic portosystemic stent shunt (TIPSS). This should lead to wider consideration and evaluation of this technique as an alternative to surgery in critically ill patients."}],"container-title":["Postgraduate Medical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/69\/818\/940\/50073262\/postgradmedj-69-940.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/69\/818\/940\/50073262\/postgradmedj-69-940.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,27]],"date-time":"2023-04-27T14:17:02Z","timestamp":1682605022000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/pmj\/article\/69\/818\/940\/7062970"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1993,12,1]]},"references-count":31,"journal-issue":{"issue":"818","published-online":{"date-parts":[[1993,12,1]]},"published-print":{"date-parts":[[1993,12,1]]}},"URL":"https:\/\/doi.org\/10.1136\/pgmj.69.818.940","relation":{},"ISSN":["0032-5473","1469-0756"],"issn-type":[{"value":"0032-5473","type":"print"},{"value":"1469-0756","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[1993,12]]},"published":{"date-parts":[[1993,12,1]]}}}