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Defining the Cause of Postpartum Myocardial Infarction - Another Use for Optical Coherence Tomography

Abdullah Alenezi1, Jadan Alsaddah1, Ossama Maadarani2

  • 1Adult Cardiology Department, Chest Diseases Hospital, Kuwait.

European Journal of Case Reports in Internal Medicine
|November 16, 2020
PubMed

Insights

Spontaneous coronary artery dissection (SCAD) is a rare cause of ST-elevation myocardial infarction (STEMI) in postpartum women. Optical coherence tomography (OCT) aids in diagnosing SCAD when angiography is uncertain.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Chest pain in postpartum women has diverse etiologies.
  • ST elevation on ECG in this demographic warrants consideration of SCAD.
  • SCAD is an increasingly recognized cause of myocardial infarction, particularly in young women.

Purpose of the Study:

  • To present a case of SCAD in a young postpartum female presenting with STEMI.
  • To highlight the diagnostic utility of OCT in confirming SCAD.
  • To emphasize SCAD as a critical consideration in postpartum STEMI.

Main Methods:

  • Case report of a young postpartum female with STEMI.
  • Diagnostic coronary angiography to assess coronary arteries.
  • Optical coherence tomography (OCT) for high-resolution imaging of coronary artery walls.

Main Results:

  • Coronary angiography showed a dilated segment in the left anterior descending (LAD) artery.
  • OCT revealed intramural hematoma (IMH) of the coronary artery wall.
  • Diagnosis of SCAD was confirmed by OCT findings.

Conclusions:

  • SCAD is the most common cause of STEMI in the postpartum state.
  • OCT provides high-resolution intracoronary imaging crucial for diagnosing SCAD.
  • Coronary angiography is the initial diagnostic step, with OCT essential for ambiguous cases.

Keywords:
Spontaneous coronary artery dissectionoptical coherence tomographypostpartum

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