Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Mar 10;5(3):ytab080.
doi: 10.1093/ehjcr/ytab080. eCollection 2021 Mar.

Spontaneous coronary artery dissection with cardiogenic shock in the third trimester, and a successful early-term delivery: a case report

Kelly E Wingerter  1 , Kimberly R O'Dell  2 , Annemarie J Anglim  3 , Alison L Bailey  4
Affiliations
Case Reports

Spontaneous coronary artery dissection with cardiogenic shock in the third trimester, and a successful early-term delivery: a case report

Kelly E Wingerter et al. Eur Heart J Case Rep. .

Abstract

Background: Acute myocardial infarction in pregnancy is occasionally due to spontaneous coronary artery dissection (SCAD). Although uncommon, the majority of cases of pregnancy-associated SCAD (pSCAD) has critical presentations with more profound defects that portend high maternal and foetal mortality, and frequently necessitate preterm delivery. This is a case of pSCAD with ongoing ischaemia that required temporary mechanical circulatory support (MCS) and emergent revascularization, while the pregnancy was successfully continued to early-term.

Case summary: A 30-year-old woman G2P1 at Week 32 of gestation with no medical history, presented to the emergency department with severe chest pain. An electrocardiogram showed ST-segment elevation in the anterolateral leads. An emergent cardiac catheterization revealed dissection of the proximal left anterior descending (LAD) artery with TIMI (thrombolysis in myocardial infarction) 3 flow. Although initially stable, she later experienced recurrent chest pain and developed cardiogenic shock, necessitating MCS, and emergent revascularization. She was stabilized and remained closely monitored in the hospital prior to vaginal delivery at early-term.

Discussion: This case of pSCAD at Week 32 of gestation complicated by refractory ischaemia illustrates the complexity of management, which requires a multi-disciplinary team to reduce both maternal and foetal mortality. Conservative management of SCAD, while preferred, is not always possible in the setting of ongoing ischaemia, particularly if complicated by cardiogenic shock. A thorough weighing of risks vs. benefits and ongoing discussions among multiple subspecialists in this case allowed for the stabilization of the patient and subsequent successful early-term delivery.

Keywords: ACS; Cardio-obstetrics; Case report; Revascularization; SCAD; Shock.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Electrocardiogram revealing acute anterolateral infarct.
Figure 2
Figure 2
Coronary angiogram with left anterior descending artery dissection and intramural haematoma.
Figure 3
Figure 3
Transthoracic echocardiogram, parasternal long-axis view showing reduced left ventricular systolic function.
Figure 4
Figure 4
Transthoracic echocardiogram, apical four-chamber view showing reduced left ventricular systolic function.
None
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Tweet MS, Hayes SN, Codsi E, Gulati R, Rose CH, Best PJ.. Spontaneous coronary artery dissection associated with pregnancy. J Am Coll Cardiol 2017;70:426–435. - PubMed
    1. Gilhofer TS, Saw J.. Spontaneous coronary artery dissection: a review of complications and management strategies. Expert Rev Cardiovasc Ther 2019;17:275–291. - PubMed
    1. Franke KB, Wong DTL, Baumann A, Nicholls SJ, Gulati R, Psaltis PJ.. Current state-of-play in spontaneous coronary artery dissection. Cardiovasc Diagn Ther 2019;9:281–298. - PMC - PubMed
    1. Patel A, Asopa S, Tang AT, Ohri SK.. Cardiac surgery during pregnancy. Tex Heart Inst J 2008;35:307–312. - PMC - PubMed
    1. Scott NS. Management of cardiovascular disease during pregnancy. US Cardiol Rev 2018;12:119–123.

Publication types

LinkOut - more resources