Spontaneous Coronary Artery Dissection Associated with Pulmonary Hemorrhage: A Case Report

Abstract

Spontaneous coronary artery dissection is becoming an important cause of acute coronary syndrome, particularly among young women. Its association with female gender, pregnancy, and postpartum period and emotional stress differentiate it from atherosclerotic heart disease. In recent years, there has been more awareness and improved diagnostic and management capabilities, which in turn has increased the diagnostic yield, although knowledge gaps remain. In the present case, a 36-year-old female, who was at 1-month postpartum period, presented with ventricular fibrillation and cardiac arrest. The clinical course was associated with pulmonary hemorrhage. The patient had no current atherosclerotic risk factors, only a family history of sudden cardiac arrest in her mother and sister. She underwent a coronary angiogram, which revealed spontaneous coronary artery dissection (SCAD) in both the left anterior descending and left circumflex artery. Percutaneous coronary intervention was performed but the clinical course was associated with pulmonary hemorrhage. Bronchopulmonary lavage was performed as a diagnostic and therapeutic intervention, and she was discharged in good health. SCAD is an important differential diagnosis in young females presenting with acute coronary syndrome or cardiac arrest. Early recognition and diagnosis are important to decrease the high mortality rate of this disease.

Keywords: Acute coronary syndrome; cardiac arrest; coronary angiography; coronary vessel anomalies; postpartum; pregnancy; pulmonary hemorrhage; spontaneous coronary artery dissection.

Figure 1

Initial coronary angiography showing dissection extending from the distal left main into the left anterior descending and left circumflex arteries (white arrow)

Figure 2

Postballoon dilatation coronary angiography showing return of TIMI II flow after balloon dilatation of left main/left anterior descending (white arrows)

Figure 3

Post-percutaneous coronary intervention angiography after performing the Coulotte technique (white arrow)