[Peripartum spontaneous coronary artery dissection: a case report]

Area of Science:

• Cardiology
• Vascular Medicine

Background:

• Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome, primarily affecting young, healthy women, often in the postpartum period.
• SCAD is characterized by a tear in the coronary artery wall without external trauma, leading to varied clinical presentations from asymptomatic to sudden cardiac death.

Observation:

• A 40-year-old woman presented with chest pain 8 weeks postpartum, initially diagnosed with non-ST-elevation myocardial infarction due to a small SCAD.
• Despite optimal medical therapy, her symptoms worsened, progressing to anterior ST-elevation myocardial infarction, necessitating percutaneous coronary intervention with stent implantation for extensive left anterior descending artery dissection.

Findings:

• The case highlights the potential for SCAD to progress rapidly, requiring intervention even after initial medical management.
• Accurate diagnosis using multiple angiographic views and advanced imaging like intravascular ultrasound or optical coherence tomography is essential for assessing lesion severity and guiding treatment.

Implications:

• The rarity and diverse presentation of SCAD limit the availability of evidence-based treatment guidelines, emphasizing the need for individualized therapeutic strategies.
• Screening for associated arterial abnormalities, such as aneurysms, is recommended due to the potential systemic nature of SCAD.