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Figure 1. The mechanism of spontaneous coronary-artery dissection, a rare cause of unstable angina, is unclear, but predisposing factors include inborn errors of metabolism and collagen synthesis. A 61-year-old woman presented with a one-hour history of chest pain suggestive of myocardial infarction. Physical examination was normal except for a blood pressure of 160/82 mm Hg. Electrocardiography revealed inferolateral T-wave inversion (Panel A). Unstable angina was diagnosed, and treatment with aspirin, beta-blockers, and intravenous heparin and nitrates was begun. The peak creatine kinase level 24 hours after admission was 286 U per liter (normal, <196). Angiography revealed a dissection flap . . . [Full Text of this Article] |
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