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Death of a young mother after sixth delivery due to coronary artery dissection

Author:

S. M. H. M. K. Senanayake

Teaching Hospital Anuradhapura, LK
About S. M. H. M. K.
Consultant Judicial Medical officer
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Abstract

Thirty six (36) years old female developed burning chest pain, was treated for gastritis by the general practitioner and was found dead on admission to the hospital 12 hours later. Postmortem examination showed hemorrhage around left coronary artery, left circumflex artery, anterior descending artery and branches, inner walls of coronary arteries compressed and lumens were collapsed. Lateral wall of the left ventricle showed pale area with hemorrhages. Cause of death was established as pulmonary oedema due to myocardial infarction following coronary artery dissection during puerperium. Most common causes for coronary artery dissection are coronary atherosclerosis and spontaneous peri-partum dissection. In peri-partum coronary artery dissections eosinophilic infiltration are seen in coronary adventitia without atherosclerosis. High estrogen levels or eosinophilic granulations contain lytic substances are thought to break down medial-adventitial layers leading to coronary artery dissection. Spontaneous coronary artery dissection occurs in relatively younger population with a predilection for women. The mean age of patients is 35 to 40 years. Left anterior descending coronary artery was the most common to involve. Some cases are diagnosed at the autopsy due to sudden deaths and some cases are presented as unstable angina and myocardial infarction. Spontaneous coronary artery dissection is a coronary abnormality needs attention in autopsies of any young person with history of chest pain or sudden death, especially women in the peri-partum period.
How to Cite: Senanayake, S.M.H.M.K., (2016). Death of a young mother after sixth delivery due to coronary artery dissection. Medico-Legal Journal of Sri Lanka. 4(2), pp.53–56. DOI: http://doi.org/10.4038/mljsl.v4i2.7339
Published on 27 Dec 2016.
Peer Reviewed

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