Pregnancy-Related Spontaneous Coronary Artery Dissection: A Case Series and Literature Review

Pregnancy-associated spontaneous coronary artery dissection (PASCAD): An etiology for chest pain in the young peripartum patient

“…8,9 Furthermore, acute MI is a significant cause of mortality and morbidity in peripartum women. 4 Remarkably, SCAD has been described as accounting for 24% to 35% of MI in women under the age of 50 and is suspected to have an even higher prevalence in women with pregnancy-related MI. 2 In pregnancy-related cases of MI, SCAD has been described as the most common mechanism and the underlying cause in 40% or more of cases.…”

“…1,5 MANAGEMENT Currently, no evidence-based management guidelines exist for SCAD or PASCAD due to its limited literature and lack of randomized control trials. 4 Early intervention for these patients is imperative to allow for optimal outcomes. Blood pressure and heart rate control to limit vessel shearing is a critical part of the initial management.…”

“…Blood pressure and heart rate control to limit vessel shearing is a critical part of the initial management. 4 It appears unclear whether standard ACS pharmaceutical agents, such as ASA or clopidogrel, are indicated; yet patients often receive these initially because they may offer some protection and minimal harm. However, more potent agents, such as glycoprotein IIb/ IIIa inhibitors, are not routinely used because they carry a higher bleeding risk and potential for extending dissection.…”

“…3 Although PASCAD can be seen at any trimester in pregnancy and up to months postpartum, the majority of cases have been reported in the third trimester or early postpartum period defined as within 6 weeks of delivery. 2,4 Abnormal electrocardiogram (ECG) changes, elevated troponins, and regional wall motional abnormalities on echocardiography are all diagnostic findings of PASCAD, which can be ultimately confirmed with coronary angiography. 1,5 Failure to immediately address this condition can lead to acute heart failure, cardiogenic shock, and death.…”

Acute Coronary Syndromes in Pregnant Women: Diagnosis, Potential Causes, Roadmap in Treatment, Experimental Studies and Hypotheses

“…The accuracy of exercise electrocardiography in the diagnosis of coronary artery disease is lower in women than in men and fetal bradycardia during maximum exercise has been reported in healthy women (20). Therefore, submaximal exercise protocol is recommended during fetal monitoring for the evaluation of ischemic myocardial disease in pregnancy (21,22). Nuclear imaging should not be performed, especially in the first trimester, especially because of the risk of teratogenesis.…”