Spontaneous coronary artery dissection (SCAD) is a very rare cause of acute coronary syndromes in young otherwise healthy patients with a striking predilection for the female gender. It was reported for the first time in 1931 at the autopsy of a 42-year-old woman.
1 Since this first report there have been about 160 case reports, the majority of which were diagnosed postmortem. The clinical presentation of SCAD depends on the extent and severity of the dissection, and ranges from unstable angina to sudden cardiac death. Although the pathological mechanism is not fully clarified, several diseases and conditions have been associated with SCAD. This implicates that SCAD is a heterogeneous disorder in which more than one therapeutic regimen should be considered. In this paper, we present two cases of young women who presented with an acute coronary syndrome due to SCAD. Of interest, both patients had a recurrence of a spontaneous dissection in another artery within a few days after the initial event. We will present a review of the literature and elaborate on the pathogenesis, therapeutic options and prognosis. …
