Spontaneous Coronary Artery Dissection in the Setting of COVID-19 Pandemic-Related Stressors: A Case Report
Alexander M Roche1, Kelsey Klingel2, Kathryn Toth3
1Internal Medicine, Maine Medical Center, Tufts University School of Medicine, Boston, USA.
Insights
Spontaneous coronary artery dissection (SCAD) can cause heart attacks, especially in young women. Recent severe emotional stress, like job loss, may trigger SCAD events and worsen outcomes.
Area of Science:
- Cardiology
- Psychosomatic Medicine
Background:
- Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial infarction (MI), particularly in young women.
- SCAD is often associated with fibromuscular dysplasia (FMD) and significant emotional stress preceding the event.
- The COVID-19 pandemic introduced societal stressors, including unemployment, potentially increasing cardiovascular morbidity.
Observation:
- A case of a female presenting with acute MI due to SCAD is described.
- The patient's MI occurred after learning of impending unemployment due to COVID-19 vaccine refusal.
- This highlights a potential link between acute emotional distress and SCAD.
Findings:
- Recent significant emotional stress, such as job loss, may precipitate SCAD and MI.
- Emotional triggers appear linked to adverse in-hospital and follow-up cardiac events in SCAD patients.
- The COVID-19 pandemic's stressors may exacerbate cardiovascular risks.
Implications:
- Clinicians should consider SCAD in patients presenting with MI, especially those with recent severe emotional stress.
- Awareness of the impact of emotional stressors, exacerbated by the pandemic, is crucial for managing chronic cardiovascular diseases.
- This case underscores the importance of addressing psychological well-being in cardiovascular patient care.
Abstract:
Spontaneous coronary artery dissection (SCAD) is an uncommon but important cause of acute myocardial infarction, particularly in younger women and in patients with underlying fibromuscular dysplasia (FMD). There is increasing literature on patients with SCAD reporting significant emotional stress, particularly stress related to unemployment, in the week prior to their cardiac event, and emotional triggers appear to be associated with worse in-hospital and follow-up cardiac events. Additionally, the COVID-19 pandemic has resulted in significant societal stressors and increased unemployment, which have been associated with increased cardiovascular morbidity. Here, we present a case of a female presenting with an acute MI secondary to SCAD in the setting of recently learning of impending unemployment due to COVID-19 vaccine refusal. This case highlights the importance of considering SCAD in patients with significant recent emotional stress who present with MI. Additionally, in light of the emotional stressors of the COVID-19 pandemic, clinicians must be aware of the consequences significant emotional stress plays on the development of adverse complications of chronic disease.
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