Pregnancy-Related Spontaneous Coronary Artery Dissection in a 25-Year-Old Woman: A Case Report

Abstract

Pregnancy-related spontaneous coronary artery dissection (P-SCAD) is a life-threatening condition that occurs during or after pregnancy, is rare and can be overlooked. It is one of the most important causes of pregnancy-related acute myocardial infarction. A 25-year-old female patient was admitted with a complaint of chest pain in her 37th week of pregnancy. There was nothing specific in her medical history except for a cesarean section, performed 2 years ago. There was diffuse ST-segment depression, and ST-segment elevation in leads V1, V2, and AVR. The patient was evaluated multidisciplinary and it was decided to perform a cesarean section and then urgently perform coronary angiography (CAG). Dissection within the lumen of the left anterior descending artery (LAD) was observed. The LAD was filling retrogradely from the right coronary artery, but no antegrade filling was observed (Type 2 SCAD). The patient, whose hemodynamics were stable and whose electrocardiography (ECG) showed no change, was monitored intubated, and stabilized in the intensive care unit (ICU) to minimize cardiac demand and reduce the risk of further myocardial ischemia. After that, an on-pump beating heart coronary artery bypass grafting (CABG) was performed 2 days later due to the high risk of bleeding related to the recent cesarean section operation. The LAD and diagonal artery were anastomosed with the left internal thoracic artery and saphenous vein grafts. She was discharged from the intensive care unit on postoperative day 2 and discharged from the hospital on day 8. P-SCAD is an important condition that can occur especially at a young age, its diagnosis may be overlooked, but it can cause serious clinical consequences. The treatment strategy should be decided in a multidisciplinary manner and should be individualized for each patient. This diagnosis should be kept in mind, especially when a young pregnant patient without cardiovascular risk factors presents with myocardial infarction findings.

Keywords: Dissection; myocardial infarction; pregnancy.

Figure 1

(a) The electrocardiogram shows ST-segment elevation in leads V1, V2, and AVR and diffuse ST-segment depression in remaining leads with sinus tachycardia. (b) The electrocardiogram shows that the ST segments have resolved.

Figure 2

(a) A coronary angiogram shows the dissection within the lumen of the left anterior descending artery (LAD) was observed. The LAD was filling retrogradely from the right coronary artery, but no antegrade filling was observed. (b) The computed tomographic angiogram shows that no flow in the proximal left main coronary artery and the ostium of LAD, and findings consistent with dissection were detected in the LAD.