Spontaneous coronary artery dissection and eosinophilic inflammation: A cause and effect relationship?

      This paper is only available as a PDF. To read, Please Download here.


      Spontaneous coronary artery dissection is described in eight patients 26 to 47 years of age. Six died suddenly, and two died after the onset of chest pain. All had normal heart weights and all had dissection of the left anterior descending coronary artery, which occurred mainly in the outer one third of the media. The adventitia of the dissected artery contained inflammatory infiltrates which were predominantly eosinophilic granulocytes. Forty-six cases previously published in 32 reports are reviewed. It is suggested that adventitial eosinophilic infiltrate may be responsible for spontaneous coronary artery dissection.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Pretty HC
        Dissecting aneurysm of coronary artery in woman aged 42: Rupture.
        Brit Med J. 1931; 1: 667
        • Uehlinger E
        Das spontane intramurale hamatom and aneurysma dissecans der normalen coronararterie.
        Schweiz Med Wochnschr. 1947; 77: 608
        • Lovitt Jr, WV
        • Corzine Jr, WJ
        Case reports: dissecting intramural hemorrhage of anterior descending branch of left coronary artery.
        AMA Arch Pathol Lab Med. 1952; 43: 458
        • Boschetti AE
        • Levine A
        Cystic medionecrosis with dissecting aneurysm of coronary arteries.
        Arch Intern Med. 1958; 102: 562
        • Schnoragel HE
        Dissecting aneurysm of coronary artery.
        J Pathol Bacteriol. 1958; 75: 464
        • Ahronheim JH
        • Wagman GI
        Dissecting hemorrhage in media of coronary artery.
        Arch Pathol Lab Med. 1959; 67: 19
        • Iglauer A
        • Schwarz J
        • Kroovand WH
        Dissecting aneurysm of coronary artery producing myomalacia and death.
        Am Heart J. 1959; 57: 630
        • McKeown F
        Dissecting aneurysm of the coronary artery in arachnodactyly.
        Br Heart J. 1960; 22: 434
        • Ralston LS
        • Wasdahl WA
        Isolated dissecting aneurysms.
        Arch Intern Med. 1960; 105: 935
        • Wells AL
        Dissecting aneurysm of coronary artery in the puerperium.
        J Pathol. 1960; 79: 404
        • Leithoff H
        Das aneurysma dissecans der herzkranzgefasse als ursache des plotzlichen todes.
        Beitr Z Gerichtl Med. 1961; 21: 208
        • Burton FJ
        • Zawadzki ES
        The coronary aneurysm.
        J Forensic Sci. 1962; 7: 486
        • Ashley PF
        Dissecting aneurysm of the coronary artery: case report.
        Del Med J. 1965; 371: 86
        • Brody GL
        • Burton JF
        • Zawadski ES
        • French AJ
        Dissecting aneurysm of the coronary artery.
        N Engl J Med. 1965; 273: 1
        • Kurrein F
        Dissecting aneurysm of the coronary artery.
        Med Sci Law. 1965; 5: 109
        • Nalbandian RM
        • Chason JL
        Intramural (intra medial) dissecting hematomas in normal or otherwise unremarkable coronary arteries: a “rare” cause of death.
        Am J Clin Pathol. 1965; 43: 348
        • Barrett DL
        Isolated dissecting aneurysm of the coronary artery: report of a case apparently due to hypersensitivity angiitis.
        Ohio Med J. 1969; 65: 830
        • Kaufman G
        • Engelbrecht WJ
        Hemorrhagic intramedial dissection of coronary artery with cystic medial necrosis.
        Am J Cardiol. 1969; 24: 409
        • Palomino SJ
        Dissecting intramural hematoma of the left coronary artery in the puerperium: a case report and survey of the literature.
        Am J Clin Palhol. 1969; 51: 119
        • Whitehead R
        • Dunnill MS
        Primary dissecting aneurysms of coronary arteries.
        J Pathol. 1969; 99: 33
        • Benson PA
        Dissecting aneurysms of right and left coronary arteries.
        J Forensic Sci. 1970; 15: 65
        • Boquist L
        • Berg P
        Multiple dissecting aneurysms in peripheral arteries.
        J Pathol. 1970; 100: 145
        • DiMaio VJM
        • Di Maio DJ
        Postpartum dissecting coronary aneurysm.
        NY State J Med. 1971; 71: 767
        • Roy JJ
        • Klein HZ
        Dissecting aneurysm of the coronary artery.
        JAMA. 1971; 218: 1047
        • Claudon DG
        • Claudon DB
        • Edwards JE
        Primary dissecting aneurysm of coronary artery. A cause of acute myocardial ischemia.
        Circulation. 1972; 45: 259
        • Degott C
        • Barge J
        • Potet F
        Aneurysme dissequent coronarien: Pose d'une observation et revue de la litterature.
        Arch Anat Pathol. 1972; 20: 25
        • Ascuncion CM
        • Hynn J
        Dissecting intramural hematoma of the coronary artery in pregnancy and the puerperium.
        Obstet Gynecol. 1972; 20: 25
        • Heefner WA
        Dissecting hematoma of the coronary artery. A possible complication of oral contraceptive therapy.
        JAMA. 1973; 223: 550
        • Bulkley BH
        • Roberts WC
        Dissecting aneurysm (Hematoma) limited to coronary artery. A clinicopathologic study of six patients.
        Am J Med. 1973; 55: 747
        • Halloch JA
        Dissecting aneurysm of coronary artery.
        N Zealand Med J. 1974; 79: 914
        • Jewett JF
        Committee on maternal welfare. Two dissecting coronary artery aneurysms post partum.
        New Engl J Med. 1978; 298: 1255
        • Pisano RV
        • Taylor MB
        • Sopher IM
        Dissection coronary artery aneurysm. A report of 2 cases.
        J Forensic Sci. 1979; 24: 18
        • Virmani R
        • Roberts WC
        Quantification of coronary arterial narrowing and of left ventricular myocardial scarring in healed myocardial infarction with chronic, eventually fatal, congestive cardiac failure.
        Am J Med. 1980; 68: 831
        • Beeson PB
        • Bass DA
        The eosinophil.
        in: 2nd ed. Major problems in internal medicine. Vol XIV. WB Saunders, Philadelphia1977: 112
        • Vercanteren RR
        • Peeters G
        On the presence of an antihistaminicum in isolated eosinophilic granulocytes.
        Arch Int Pharmacolodyn Ther. 1952; 89: 10
        • Gleich GJ
        • Loegering DA
        • Maldonado JE
        Identification of a major basic protein from guinea pig eosinophil granules.
        J Exp Med. 1973; 137: 1459
        • Butterworth AE
        • Wasson DL
        • Gleich GJ
        • Loegering DA
        • David JR
        Damage to schistosomula of Schistosoma mansoni induced directly by eosinophilic major basic protein.
        J Immunol. 1979; 122: 221
        • Wasson DL
        • Gleich GJ
        Damage to Trichinella spiralis newborn larvae by eosinophil basic protein.
        Am J Trop Med Hyg. 1979; 28: 860
        • Gleich GJ
        • Frigas E
        • Loegering DA
        • Wasson DL
        • Steinmuller D
        Cytotoxic properties of the eosinophil major basic protein.
        J Immunol. 1979; 123: 2925
        • Parrillo JE
        • Fauci AS
        Human eosinophils. Purification and cytotoxic capability of eosinophils from patients with the hypereosinophilic syndrome.
        Blood. 1978; 51: 457