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]