Postpartum spontaneous coronary artery dissection complicated by ventricular fibrillation: a case report

Spontaneous coronary artery dissection (SCAD) is an uncommon but increasingly recognized cause of acute coronary syndrome (ACS), particularly in young women without traditional cardiovascular risk factors. Although SCAD frequently presents as myocardial infarction, life-threatening arrhythmic complications such as cardiac arrest remain rare and may complicate timely diagnosis and management. Pregnancy-associated SCAD is associated with increased clinical severity and a higher risk of complications. This case is notable for the occurrence of ventricular fibrillation arrest, as well as the coexistence of SCAD with features of stress-induced cardiomyopathy.

A 33-year-old African American female, 9 days postpartum following an uncomplicated vaginal delivery, presented with severe chest pain and shortness of breath. Electrocardiogram demonstrated findings concerning for ST-segment elevation myocardial infarction. Shortly after presentation, she developed ventricular fibrillation arrest requiring cardiopulmonary resuscitation. Coronary angiography revealed SCAD involving the left anterior descending artery. Given the high procedural risk of intervention, conservative management was pursued. Echocardiography showed severely reduced left ventricular systolic function with apical akinesis suggestive of stress-induced cardiomyopathy. The patient was treated with guideline-directed medical therapy and a wearable cardioverter-defibrillator, with subsequent improvement in left ventricular ejection fraction and clinical stability at discharge.

This case highlights a rare and unique presentation of SCAD complicated by ventricular fibrillation cardiac arrest in the postpartum period. Recognition of SCAD in patients presenting with apparent myocardial infarction but lacking traditional atherosclerotic risk factors is critical, as management strategies differ substantially from conventional ACS treatment. Early identification and individualized management may improve outcomes and prevent potentially harmful interventions. Clinicians should maintain heightened awareness of SCAD as a cause of malignant arrhythmia and cardiac arrest in younger women, particularly in the peripartum population. Additionally, this case underscores the role of conservative therapy and temporary defibrillator support in patients with anticipated recovery of ventricular function.