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Case Reports
. 2021 Dec 7;14(12):e244851.
doi: 10.1136/bcr-2021-244851.

Pregnancy-associated spontaneous coronary artery dissection: multidisciplinary management, challenges and literature review

Nnadozie Igbokwe  1 , Jess Gomersall  2 , Sunday Paul Ugwoke  2 , Sean Esmonde  3
Affiliations
Case Reports

Pregnancy-associated spontaneous coronary artery dissection: multidisciplinary management, challenges and literature review

Nnadozie Igbokwe et al. BMJ Case Rep. .

Abstract

A 30-year-old woman in her second pregnancy, which was complicated by gestational diabetes mellitus. She had an uneventful spontaneous vaginal delivery at 38 weeks+3 days of gestation. Day 1 postpartum, she developed sudden chest pain radiating to her jaw and neck. Her observations were normal, and ECG showed lateral ST elevation in keeping with acute myocardial infarction. The troponin-T level was elevated at 21 ng/L at 0 hour, and >10 000 ng/L at 12 hours, respectively. Coronary angiography confirmed spontaneous dissection of the proximal left anterior descending (LAD) and proximal circumflex coronary arteries. She became unstable during percutaneous coronary intervention and consequently had a successful coronary artery bypass surgery with left saphenous vein grafts to the first obtuse marginal artery and LAD. Echocardiogram revealed moderate to severe impairment of the left ventricular function postoperatively.

Keywords: interventional cardiology; pregnancy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Twelve-lead ECG at presentation showing ST-segment elevation in leads I, aVL and V4–6, with reciprocal depression in III, aVF, aVR and V1 suggesting lateral myocardial infarction. aVF, augmented vector foot; aVL, augmented vector left; aVR, augmented vector right.
Figure 3
Figure 3
Final coronary angiographic shot showing extremely poor flow in the left coronary arteries.
Figure 2
Figure 2
First diagnostic coronary angiographic shot showing complete occlusion of both LAD and LCx arteries. LAD, Left Anterior Descending; LCx, Left Circumflex.
Figure 4
Figure 4
Intravascular ultrasound (IVUS) image showing intra-mural haematoma (red arrows) compressing the true coronary lumen (white arrows) with intra-luminal coronary wire artefact (green arrow). No dissection flap is seen, suggesting type 2 spontaneous coronary artery dissection.
Figure 5
Figure 5
ECG at discharge showing resolving ST-segment elevation in leads I and aVL, with Q-waves in leads I and aVL, poor R-wave progession in the precordial leads and T-wave inversion in leads III and aVF. aVL, augmented Vector Left; aVF, augmented Vector Foot.
See this image and copyright information in PMC

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References

    1. Ryshten N, Janssens L, Ector B. Acute myocardial infarction due to spontaneous postpartum multi-vessel coronary artery dissection. J Cardiol Cases 2014;9:80–3. 10.1016/j.jccase.2013.10.005 - DOI - PMC - PubMed
    1. Havakuk O, Goland S, Mehra A, et al. . Pregnancy and the risk of spontaneous coronary artery dissection: an analysis of 120 contemporary cases. Circ Cardiovasc Interv 2017;10. 10.1161/CIRCINTERVENTIONS.117.004941 - DOI - PubMed
    1. Hassan S, Prakash R, Starovoytov A, et al. . Natural History of Spontaneous Coronary Artery Dissection With Spontaneous Angiographic Healing. JACC Cardiovasc Interv 2019;12:518–27. 10.1016/j.jcin.2018.12.011 - DOI - PubMed
    1. Paratz ED, Kao C, MacIsaac AI, et al. . Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review. Int J Cardiol Heart Vasc 2018;18:1–6. 10.1016/j.ijcha.2017.12.001 - DOI - PMC - PubMed
    1. Adlam D, Alfonso F, Maas A, et al. . European Society of cardiology, acute cardiovascular care association, SCAD Study group: a position paper on spontaneous coronary artery dissection. Eur Heart J 2018;39:3353–68. 10.1093/eurheartj/ehy080 - DOI - PMC - PubMed

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