Pregnancy-associated spontaneous coronary artery dissection: multidisciplinary management, challenges and literature review

Abstract

A 30-year-old woman in her second pregnancy, which was complicated by gestational diabetes mellitus. She had an uneventful spontaneous vaginal delivery at 38 weeks+3 days of gestation. Day 1 postpartum, she developed sudden chest pain radiating to her jaw and neck. Her observations were normal, and ECG showed lateral ST elevation in keeping with acute myocardial infarction. The troponin-T level was elevated at 21 ng/L at 0 hour, and >10 000 ng/L at 12 hours, respectively. Coronary angiography confirmed spontaneous dissection of the proximal left anterior descending (LAD) and proximal circumflex coronary arteries. She became unstable during percutaneous coronary intervention and consequently had a successful coronary artery bypass surgery with left saphenous vein grafts to the first obtuse marginal artery and LAD. Echocardiogram revealed moderate to severe impairment of the left ventricular function postoperatively.

Spontaneous Coronary Artery Dissection Associated with Pulmonary Hemorrhage: A Case Report

“…In the present case, the high-risk features included a strong family history of sudden cardiac death in her sister and mother, involvement of the LM artery dissection, and hemodynamic instability. [ 2 9 ]…”

“…Spontaneous coronary artery dissection (SCAD), an emergency ischemic event, forms a false lumen that compresses the true lumen of the coronary vessel, resulting in cardiac ischemia and acute coronary syndrome. [ 1 2 ] In the pre- and postpartum periods, patients with SCAD are likely to present with an ST-elevation myocardial infarction (STEMI). SCAD is significantly correlated with multiparity, infertility treatment, and pre-eclampsia as well as connective tissue diseases.…”