Spontaneous coronary and vertebral artery dissection in early pregnancy

A nulliparous woman presented to the hospital at 11 weeks' gestation with acute onset chest pain, non-specific ECG changes and mildly elevated cardiac enzymes despite having no cardiac risk factors. She re-presented 4 days later with chest and arm pain, and ECG changes consistent with a posteroinferior ST elevation myocardial infarction. She was diagnosed with a spontaneous coronary artery dissection on a coronary angiogram and a right vertebral artery dissection on CT scan. Subsequent extension of the coronary dissection 4 days later required a coronary artery bypass graft. The patient elected to continue the pregnancy, while acknowledging the maternal and fetal risks. At 28 weeks' gestation, the fetus had dilated small bowel loops on the obstetrical ultrasound. At 33+4 weeks' gestation, a 2154 g male infant was born by emergency Caesarean section for non-reassuring cardiotocography. The infant had jejunal atresias, requiring bowel resection and primary anastomoses.