Abstract: Objective　To improve the understanding of pathogenesis，clinical features，diagnosis and treatment of spontaneous coronary artery dissection.Methods　One patient with chest pain was admitted to Zhejiang Provincial People's Hospital in 29 November 2017，diagnosed with spontaneous coronary artery dissection.The diagnosis and treatment process of the patient were analyzed and related literature was reviewed.Results　 A 45-year-old female patient was admitted to the hospital because of chest pain for 10 hours after a jump.Troponin I was positive，electrocardiogram （ECG）showed V1-V5 lead ST segment elevation.Coronary arteriongraphy showed rat tail sign in the anterior descending artery，and she was diagnosed as spontaneous coronary artery dissection.After percutaneous coronary intervention （PCI），antiplatelet，anticoagulation，lipid-lowering and plaque stabilization，inhibition of myocardial remodeling，nutritional myocardium for microcirculation were given in symptomatic supportive treatment.The symptom of chest pain was gradually improved.Chest pain did not recur in half a year after follow-up.Conclusion　 It is difficult to distinguish spontaneous coronary artery dissection with acute coronary syndrome due to coronary atherosclerotic heart disease，but the treatment and prognosis of them are so different.Reviewing relevant literature can improve the understanding of spontaneous coronary artery dissection，and facilitate differential diagnosis.

Key words: Aneurysm, dissecting；Spontaneous coronary artery dissection；Chest pain；Case reports；Historical article

摘要： 目的　提高对自发性冠状动脉夹层的发病机制、临床特征、诊断和治疗的认识。方法　2017-11-29 1例胸痛患者入住浙江省人民医院，诊断为自发性冠状动脉夹层，分析患者的诊治过程并进行相关文献复习。结果　1例45岁女性患者，因“一次跳跃动作后胸痛10 h”入院，肌钙蛋白I阳性，心电图示V1~V5导联ST段抬高，冠状动脉造影示左前降支远段鼠尾征，诊断为自发性冠状动脉夹层。经皮冠状动脉介入术（PCI）后予抗血小板、抗凝、降脂稳定斑块、抑制心肌重塑、营养心肌改善微循环等对症支持治疗，患者胸痛症状逐渐改善。随访半年时间内胸痛症状未再发。结论　自发性冠状动脉夹层与冠状动脉粥样硬化性心脏病引起急性冠状动脉综合征临床表现相似，鉴别困难，而治疗和预后相距甚远。复习相关文献，提高对自发性冠状动脉夹层的认识，利于鉴别诊断。

关键词: 动脉瘤, 夹层；自发性冠状动脉夹层；胸痛；病例报告；历史文献