Images:
Figure 1A-C: Hayes et al [1] illustration of coronary
artery intramural hematoma formation. A: Normal coronary artery. B:
Coronary artery with intramural hematoma. C: Coronary artery with
intimal tear. Spontaneous coronary artery dissection is characterized by
the spontaneous formation of an intramural hematoma, which can lead to
compression of the true lumen and myocardial infarction. An intimal tear
may be present.
Figure 2A-B: A, initial electrocardiogram: V1 T-wave inversions
and V2 biphasic T-waves. B, repeat electrocardiogram: V1 persistent
T-wave inversions, V2 T-wave inversions, and V3 biphasic T-waves.
Figure 3A-B: Echocardiographic 4 chamber view during
ventricular diastole (A, left) followed by ventricular systole (B,
right) showing mildly reduced ejection fraction (45%) with akinetic
apical left ventricular wall segments: anterior, septal, inferior,
lateral including the apex.
Figure 4 A-B: A (left) : Coronary angiography showing
luminal narrowing of left main coronary artery (red arrow) and
radiolucent intraluminal hematoma (blue circle) in the proximal LAD with
long narrowing (blue arrows) in the middle LAD. B (right) : Post
PCI coronary angiography with restoration of normal caliber in the left
main coronary (red arrow) as well as the proximal and middle LAD (blue
arrows).
Figure 5: Spontaneous coronary artery dissection Type 1-4
[8]