A case of Sudden Cardiac Death with myocardial infarction due to iatrogenic coronary dissection in a patient with coronary vasospasm.

Abstract

Coronary vasospasm and coronary artery dissection are two recognized causes of Sudden Cardiac Death [SCD] in association with Myocardial Infarction in Non-Obstructive Coronary Artery [MINOCA]. This is a case of post procedure death in a 50-year-old female during cardiac angiography, who had a family history of coronary spasm with sudden cardiac death in her mother. She went into cardiac arrest during the procedure with iatrogenic acute coronary dissection which was treated with LMS/LCx vessel stenting. However, she died in 4 days post procedure. Postmortem cardiac examination demonstrated a transmural hemorrhagic infarction of the entire circumferential wall of the left ventricle with normal coronaries both macroscopically and microscopically. Acute coronary dissection was confirmed histologically in the left main stem.Coronary vasospasm is transient constriction of coronary arteries, which causes partial or complete obstruction of the vessels. The exact pathophysiological mechanism is poorly understood, but atheroma, drugs and a genetic predisposition are common associations. This case highlights the strong genetic link of coronary vasospasm in both mother and daughter and also the complication of iatrogenic coronary dissection which is a rare, but serious complication reported in about 0.1% of coronary angiography. This is the first postmortem report of procedure-related dissection in a patient with vasospasm indicating the cause is functional. Forensic practitioners need to be aware of coronary vasospasm and the complications of coronary angiography as a cause of acute myocardial infarction. Detailed autopsy yields valuable information in this rare condition.