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Case Reports
. 2019 Jan-Dec:7:2324709619874624.
doi: 10.1177/2324709619874624.

Preeclampsia-Associated Multivessel Spontaneous Coronary Artery Dissection

Rajeev Virender Seecheran  1 , Jessica Kawall  1 , Divya Ramadhin  2 , Valmiki Krishna Seecheran  1 , Sangeeta Anjali Persad  1 , Sasha Savitri Lalla  2 , Naveen Anand Seecheran  3
Affiliations
Case Reports

Preeclampsia-Associated Multivessel Spontaneous Coronary Artery Dissection

Rajeev Virender Seecheran et al. J Investig Med High Impact Case Rep. 2019 Jan-Dec.

Abstract

Pregnancy-associated spontaneous coronary artery dissection (PASCAD) accounts for less than 5% of spontaneous coronary artery dissection cases and is comparatively more fulminant or clinically aggressive. Several factors associated with PASCAD include black ethnicity, multiparity, hypertension, advanced maternal age, and age at first childbirth. This atypical case highlights a preeclamptic patient presenting with an ST-segment elevation myocardial infarction in which multivessel dissection of both the left anterior descending and right coronary arteries were deemed co-culprit lesions for the index event.

Keywords: PASCAD; SCAD; ST-segment elevation myocardial infarction; STEMI; multivessel dissection; preeclampsia; pregnancy-associated spontaneous coronary artery dissection; spontaneous coronary artery dissection.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Index presentation electrocardiogram (ECG). There is marked 5- to 6-mm convex ST-segment elevation in the inferior leads of II, II and aVF (left-sided arrows) with ST depression in leads V1-V2, suggestive of an inferoposterior myocardial infarction. Additionally, there is similar ST-segment elevation in leads V4-V6 (right-sided arrows box), suggestive of an anterolateral myocardial infarction. Overall, the ECG displays a diffusely ischemic picture typically reflected in left main or multivessel coronary artery disease.
Figure 2.
Figure 2.
Cineangiography series of the left coronary artery (LCA). (a) Right anterior oblique (RAO) angiographic view of the left anterior descending (LAD) artery with the white arrows subtending the type 2A pregnancy-associated spontaneous coronary artery dissection (PASCAD). (b) “Steep” RAO angiographic view of the LAD artery with the white arrows subtending the type 2A PASCAD. (c) Straight cranial view of the LAD artery with the white arrows subtending the type 2A PASCAD.
Figure 3.
Figure 3.
Cineangiography series of the right coronary artery (RCA). (a) Left anterior oblique angiographic view of the RCA with the white arrow indicating the type 2A pregnancy-associated spontaneous coronary artery dissection (PASCAD). (b) Right anterior oblique angiographic view of the RCA artery with the white arrow indicating the type 2A PASCAD.
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