Spontaneous Coronary Artery Dissection Associated With Pregnancy

Abstract

P-SCAD patients had more acute presentations and high-risk features than women with NP-SCAD did. The highest frequency of P-SCAD occurred during the first postpartum month and P-SCAD patients less often had extracoronary vascular abnormalities. Hormonal, hemodynamic variations, and yet-undefined mechanisms might be significant contributors to P-SCAD. (The "Virtual" Multicenter Spontaneous Coronary Artery Dissection [SCAD] Registry [SCAD]; NCT01429727; Genetic Investigations in Spontaneous Coronary Artery Dissection [SCAD]; NCT01427179).

Peripartum cardiomyopathy

“…Because circulating plasma volume and cardiac output increase by 50% by the late second trimester and then plateau for the remainder of pregnancy,83 women with these conditions tend to present with dyspnea and heart failure earlier in pregnancy than do women with PPCM; however, it should be noted that heart failure caused by pre-existing cardiomyopathy or valvular disease can also sometimes present late in pregnany 13. The risk of myocardial infarction, from atherosclerotic plaque rupture or spontaneous coronary artery dissection, is three to four times higher in the peripartum period and, more commonly, the early postpartum period compared with non-pregnant women,84 and it may present with chest pain, dyspnea, heart failure, or a combination thereof 8586. The differential diagnosis also includes pulmonary embolism, the risk of which is five to 10 times higher during pregnancy and the postpartum period,87 and amniotic fluid embolism, a condition marked by shock and respiratory failure during labor or immediately postpartum.…”

Spontaneous coronary artery dissection in women: What is known and what is yet to be understood

“…9 Among women, SCAD is the etiology of acute coronary syndrome (ACS) in as many as 35% of cases 8,10 and the most common etiology of MI associated with pregnancy. 11,12 …”

“…3,5–8,12,13 Classic modifiable risk factors for atherosclerosis are not common among SCAD patients. In 2 recent series with >300 SCAD patients each, diabetes mellitus was present in only 0.9% to 4.6%, smoking in 0.6% to 10%, hypertension in 27% to 36%, and mean body mass index was 24 kg/m 2 5,12 . Although SCAD has been reported in virtually every race and ethnicity and in most world geographical regions, most reported SCAD patients in contemporary series and registries are white women.…”

“…This may be related to selection bias, access to healthcare and research, pathophysiology of SCAD, or other unknown factors. 5,12 …”

“…3,5–8,12 Although SCAD patients may present with chest pain and other ischemic symptoms, the initial electrocardiogram and troponin levels may be normal; thus, serial evaluations are advised in those with concerning symptoms. 14 Some patients with history of SCAD report stuttering chest pain or a possible inciting trigger in the days prior to their ACS, suggesting that the SCAD may evolve before causing clinically urgent myocardial injury.…”