title: Sudden cardiac death due to coronary artery dissection as a complication of cardiac sarcoidosis.
abstract: Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), cardiac tamponade and sudden cardiac death that typically affects young women in the postpartum period. Rarely, it can be caused by systemic inflammatory conditions such as sarcoidosis. Sarcoidosis is an inflammatory disease most often affecting the lung and lymph nodes that can sometimes affect the heart. The authors report a case of sudden cardiac death caused by SCAD in the context of undiagnosed and subclinical cardiac sarcoidosis. The decedent was a 47-year-old male with a relatively innocuous past medical history. He was found dead in bed. At autopsy, there was a lethal hemopericardium resulting in cardiac tamponade. Gross examination of the heart revealed dissection of the posterior descending coronary branch of the right coronary artery. Histologically, the coronary artery showed acute and organizing dissection with evidence of vasculitis. A chronic inflammatory infiltrate consisting of lymphocytes, histiocytes, eosinophils and giant cells was seen. Sections of the myocardium showed myocarditis with a nonnecrotizing granuloma. The death was attributed to cardiac tamponade secondary to SCAD in the context of systemic sarcoidosis. The presented case demonstrates two concurrent rare pathologies and highlights the importance of considering SCAD in cases of sudden cardiac death at autopsy.
authors: Hamilton Centre for Kidney Research, St. Joseph's Hospital, Hamilton, Ontario, Canada L8N 4A6. Electronic address: savas.kanaroglou@uqconnect.edu.au.
authors: Savas
authors: S
authors: Kanaroglou
authors: Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada L8L2X2; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada L8N3ZS. Electronic address: nairvid@hhsc.ca.
authors: Vidhya
authors: V
authors: Nair
authors: Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada L8L2X2; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada L8N3ZS. Electronic address: fernandes@hhsc.ca.
authors: John R
authors: JR
authors: Fernandes
mesh_terms: D000784:Aortic Dissection / Q000209:etiology* / Q000473:pathology; D001344:Autopsy; D009202:Cardiomyopathies / Q000209:etiology* / Q000473:pathology; D002423:Cause of Death; D003323:Coronary Aneurysm / Q000209:etiology* / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000473:pathology; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D012507:Sarcoidosis / Q000150:complications* / Q000473:pathology
keywords: Sarcoidosis; Spontaneous coronary artery dissection; Sudden cardiac death; Vasculitis