Spontaneous coronary artery dissection: 3 cases - Hormonal, autoimmune, morphological factors

Abstract

The number of cases with spontaneous coronary artery dissection (SCAD) is considered to be being underestimated because of a large amount of SCAD leading to sudden death without previous diagnosis. Besides, not only in clinics but also in autopsy practice, correct diagnosis of SCAD is important to prevent forensic malpractice. The article is intended to discuss the pathological findings through the forensic point of view for improving the malpractice expertise in scope of clinicians- timely antemortem diagnosis according to risk factors and in scope of forensic pathologists- the cause of death determination ability according to macroscopical and microscopical findings of the autopsy. In 3 cases reported, the main characteristics were the female sex, pregnancy history and a sudden death without any trauma. However, although there are many women giving birth or using oral contraceptives, only some of them are facing with SCAD. This suggests the possibility of some hereditary factors, whereas hereditary characteristics may be understood in many different ways like hormone-releasing regulating mechanisms as well as immunity, morphology, or any other mechanism. For instance, autoimmunity has been also a hereditary underlying factor for vessel injury considered in presented cases.