title: Spontaneous coronary artery dissection in a patient with systemic lupus erythematosis.
abstract: Spontaneous coronary artery dissection (SCAD) is an uncommon condition that may lead to sudden coronary artery occlusion resulting in a fatal acute myocardial infarction. It usually affects young to middle age women. A Medline search from 1966 to 2001 (using keywords: coronary artery dissection and systemic lupus erythematosis) revealed no prior reports of coronary dissection in a patient with systemic lupus erythematosis (SLE). We describe a 48-year old woman with SLE who sustained a fatal spontaneous left main coronary artery dissection. Coronary angiogram was notable for marked variability in the size of coronary lumen from systole to diastole. This case demonstrates the need to consider SCAD in the evaluation of chest pain and myocardial infarction in patients with SLE. Furthermore, in the absence of classical angiographic findings of coronary dissection, a detailed review of phasic changes in coronary lumen during a cardiac cycle could help reach this diagnosis.
authors.affiliation: Division of Cardiology, Washington Hospital Center, USA arvshar@aol.com
authors.forename: Arvind K
authors.initials: AK
authors.lastname: Sharma
authors.forename: Andrew
authors.initials: A
authors.lastname: Farb
authors.forename: Parimal
authors.initials: P
authors.lastname: Maniar
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Ajani
authors.forename: Marco
authors.initials: M
authors.lastname: Castagna
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
authors.forename: William
authors.initials: W
authors.lastname: Suddath
authors.forename: Joseph
authors.initials: J
authors.lastname: Lindsay
mesh_terms: D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D017023:Coronary Angiography; D017809:Fatal Outcome; D005260:Female; D006327:Heart Block / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008875:Middle Aged; D012307:Risk Factors; D015607:Stents