Spontaneous right coronary artery dissection: causing myocardial infarction in a 36-year-old woman

Spontaneous coronary artery dissection is a rather rare cause of myocardial infarction, chest pain, and sudden death. Since the condition was first described in 1931, fewer than 200 cases have been reported in the medical literature. There are currently no known direct causes of this condition, although some correlations have been noted. Many patients are women in the peripartum period or of childbearing age, with few or no risk factors for coronary artery disease. Other associations include contraceptive use and connective-tissue disorders, Ehlers-Danlos and Marfan syndromes, and polyarteritis nodosa. Most of the reported dissections have occurred in the left anterior descending coronary artery. Herein, we report the case of a 36-year-old woman who presented at our institution with an acute ST-elevation myocardial infarction secondary to a spontaneous dissection of the right coronary artery. Thrombectomy and stenting resolved the occlusion of the artery, and the patient was discharged from the hospital on medical therapy. We discuss the pathophysiology, presentation, and treatment of this rare and often fatal condition.