Letter to the Editor May emergency hypertension be reason of spontaneous coronary artery dissection? Ersan Tatli ⁎ , Armagan Altun Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey Received 10 November 2008; accepted 15 November 2008 Available online 30 December 2008 Abstract Spontaneous coronary artery dissection is an uncommon clinical condition. It has most often been described in healthy peripartum women with no risk factors for atherosclerosis. We present a patient of a 40 year-old man with emergency hypertension. His coronary angiography revealed dissection of the left anterior descending coronary artery which was treated with angioplasty and stenting. We postulate that emergency hypertension may be a reason of spontaneous coronary artery dissection. © 2008 Elsevier Ireland Ltd. All rights reserved. Keywords: Emergency hypertension; Spontaneous coronary artery dissection; Acute coronary syndrome 1. Introduction Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute coronary syndrome. The incidence, causes, pathogenesis and treatment have not been clearly defined. Two main types of SCAD can be identified: the first one occurs in patients with atherosclerotic coronary disease and the second one occurs in patients without atherosclerotic coronary disease [1]. Hypertension has not been associated with SCAD. We present a patient of a 40 year-old man with emergency hypertension and coronary artery dissection which was successfully treated angioplasty and stenting. We postulate that emergency hypertension may be reason of SCAD. 2. Clinical case A 40 year-old man presented to our department with retrosternal chest pain and severe headache. He had a history of hypertension without other risk factors for atherosclerosis. On examination, heart rate was 86 bpm and blood pressure was 230/130 mm Hg. Auscultation of heart and lung fields were normal. An electrocardiogram showed normal sinus rhythm with 2 mm ST segment depression in anterior leads. Thranstorasic echocardiography showed normal left ventricular systolic function with and grade 1 diastolic dysfunction. The patient was admitted to coronary care unit with diagnoses of International Journal of Cardiology 140 (2010) e53 – e54 www.elsevier.com/locate/ijcard ⁎ Corresponding author. Tel.: +90 2842357641/2150, +90 5056789099 (Telephone GSM); fax: +90 2842357652. E-mail address: ersantatli@yahoo.com (E. Tatli). Fig. 1. Coronary angiogram in the left anterior oblique view showing dissection of the proximal left anterior descending artery. 0167-5273/$ - see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2008.11.079