Acute coronary syndrome in post-partum period: challenge for differential diagnosis and proper management

Area of Science:

• Cardiology
• Vascular Medicine
• Diagnostic Imaging

Background:

• Acute coronary syndrome (ACS) presents with diverse clinical manifestations.
• Coronary artery aneurysms are rare but serious vascular abnormalities.
• Accurate diagnosis is crucial for appropriate management of complex coronary artery disease.

Purpose of the Study:

• To report a case of left anterior descending artery aneurysm and stenosis.
• To highlight the diagnostic utility of advanced imaging in ACS.
• To discuss the management of complex coronary artery disease.

Main Methods:

• Clinical presentation with chest pain, ECG changes, elevated cardiac biomarkers (troponin, NT-proBNP), and D-dimer.
• Echocardiography revealed wall motion abnormalities.
• Chest computed tomography angiography excluded pulmonary embolism and identified a left anterior descending artery aneurysm.
• Coronary angiography confirmed the aneurysm and significant stenosis in the coronary artery.

Main Results:

• The patient presented with symptoms consistent with acute coronary syndrome.
• Computed tomography angiography and coronary angiography identified a sac-like aneurysm of the left anterior descending artery (LAD) and 80% stenosis of the a. intermedia.
• The interventional cardiology team determined the need for coronary artery bypass grafting (CABG) due to extensive vessel damage.

Conclusions:

• Left anterior descending artery aneurysm with significant stenosis is a critical finding in patients presenting with ACS.
• Multimodality imaging plays a vital role in diagnosing complex coronary artery pathology.
• Coronary artery bypass grafting is a viable treatment option for extensive coronary artery damage, including aneurysms and stenosis.