Postpartum spontaneous coronary dissection presenting with ventricular fibrillation

Abstract

Background: Spontaneous coronary artery dissection is a rare cause of acute coronary syndromes; and one quarter of these patients present during the post-partum period. Furthermore, ventricular fibrillation is a rare presentation of this disease entity.

Case: A 32-year-old woman presented 3 days post Cesarean-section delivery with chest pain, ischemic electrocardiogram changes, and ventricular fibrillation arrest. The patient was taken for cardiac catheterization and found to have a left anterior coronary artery dissection necessitating 6 stents to restore flow to the vessel.

Conclusion: We report the first case of survival after ventricular fibrillation arrest of a woman presenting with spontaneous coronary dissection in the post-partum period. Our case underscores the importance of recognizing ventricular fibrillation as a first presenting sign of spontaneous coronary artery dissection in the post-partum period.

Keywords: Arrest; Coronary; Dissection; Postpartum; Survival; V-fib.

Figure 1

Initial electrocardiograph displaying ST elevation in the anterior leads.

Figure 2

Initial rhythm strip displaying ventricular fibrillation and the change with shock.

Figure 3

A long segment of the left anterior descending artery was dissected at different points along the vessel (thin arrows). Only minimal response to intracoronary nitroglycerin was seen indicating the vessel was dissected, rather than spastic.

Figure 4

Three intra-coronary stents (2.25 mm × 32 mm deployed at 12 atm, 2.25 mm × 28 mm deployed at 10 atm, and 2.75 mm × 32 mm deployed at 14 atm, respectively) were placed (full arrows), and Thrombolysis In Myocardial Infarction 3 flow was restored.

Figure 5

The left anterior descending artery, proximal to the prior intra-coronary stents further dissected (thin arrows).

Figure 6

Three additional intra-coronary stents (3.0 mm × 20 mm deployed at 10 atm, 2.25 mm × 20 mm deployed at 12 atm, and 3.0 mm × 8 mm deployed at 8 atm, respectively) were placed (full arrows) into the proximal left anterior descending artery, and Thrombolysis In Myocardial Infarction 3 flow was restored.