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Spontaneous coronary artery dissection following induced vaginal delivery
Agata Stawska1, Szymon Kaczyński1, Małgorzata Głogiewicz1
1DEPARTMENT AND CLINIC OF OBSTETRICS, GYNECOLOGICAL DISEASES AND ONCOLOGIC GINECOLOGY, JAN BIZIEL UNIVERSITY HOSPITAL No. 2 IN BYDGOSZCZ, BYDGOSZCZ, POLAND.
Insights
Spontaneous coronary artery dissection (SCAD) can cause heart attacks in pregnant women. This case highlights SCAD as a cause of acute myocardial ischemia in a postpartum woman, emphasizing the need for awareness in young women.
Area of Science:
- Cardiology
- Obstetrics & Gynecology
Background:
- Cardiovascular diseases are a leading cause of maternal mortality.
- Spontaneous coronary artery dissection (SCAD) is an underrecognized cause of myocardial infarction in young women, including during pregnancy.
- Pregnancy-related SCAD incidence is unknown, but potential triggers include physical exertion, stress, and hormonal changes.
Purpose of the Study:
- To present a clinical case of acute coronary syndrome secondary to SCAD in a postpartum woman.
- To highlight SCAD as a cause of myocardial ischemia in young women without traditional cardiovascular risk factors.
Main Methods:
- Case report of a 32-year-old woman in the early postpartum period presenting with acute coronary syndrome.
- Urgent coronary angiography to diagnose SCAD.
- Percutaneous transluminal coronary angioplasty (PTCA) for treatment.
Main Results:
- Coronary angiography revealed critical 90% stenosis of the left anterior descending artery (LAD) due to SCAD.
- Successful PTCA achieved effective myocardial reperfusion.
- The patient experienced acute myocardial ischemia despite low cardiovascular risk.
Conclusions:
- SCAD is a critical consideration in young women, including those in the postpartum period, presenting with acute myocardial ischemia.
- Physicians should consider SCAD in young women with acute coronary syndrome, even in the absence of significant cardiovascular risk factors.
- Increased awareness and prompt diagnosis of SCAD are crucial for effective management and improved outcomes.
Abstract:
Cardiovascular diseases represent a significant threat to the health and life of women during pregnancy and the postpartum period, accounting for 13% of all maternal deaths and constituting the third most common cause of perinatal mortality. A particular cause of myocardial infarction in young women, including pregnant patients, is spontaneous coronary artery dissection (SCAD).The occurrence of spontaneous coronary artery dissection may be preceded by triggering factors such as intense physical exertion, intense Valsalva manoeuvres, emotional or physical stress, labour, as well as exposure to exogenous hormones and β hCG. Despite the increasing number of reported cases, the true incidence of pregnancy related SCAD remains unknown. The presented clinical case describes an acute coronary syndrome in a 32-year-old woman in the early postpartum period, secondary to spontaneous coronary artery dissection. The patient was qualified for urgent coronary angiography, which revealed critical, ninety-percent stenosis of the left anterior descending coronary artery (LAD). Following percutaneous transluminal coronary angioplasty, effective myocardial reperfusion was achieved. Young women with low cardiovascular risk and without clinically significant risk factors may develop acute myocardial ischaemia.
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