Spontaneous dissection of the left anterior descending coronary artery

Spontaneous coronary artery dissection is a very rare, but increasingly reported cause of myocardial infarction or sudden cardiac death. In most cases, diagnosis is made on postmortem examinations. In a minority of cases, it is detected incidentally on angiographic studies during or after an acute coronary syndrome. We present a 49-year-old man who had atherosclerotic risk factors, stable angina pectoris, and decompensated heart failure. Following medical stabilization of the patient, coronary angiography revealed a linear dissection of the left anterior descending coronary artery. On thallium scintigraphy, anterior and inferior myocardial infarction was detected, so percutaneous or surgical revascularization were not considered and the patient was submitted to cardiac transplantation.