Published online Apr 26, 2021. doi: 10.4330/wjc.v13.i4.103
Peer-review started: November 30, 2020
First decision: December 20, 2020
Revised: January 1, 2021
Accepted: March 18, 2021
Article in press: March 18, 2021
Published online: April 26, 2021
Processing time: 141 Days and 13.8 Hours
Pregnancy-associated spontaneous coronary artery dissection (PSCAD) is an important cause of chest pain and acute myocardial infarction in pregnant and postpartum women. Pregnancy is considered an isolated risk factor for spontaneous coronary artery dissection. The etiology, pathogenesis, and incidence of PSCAD are not known.
We present a case of a 33-year-old postpartum female who presented with sudden onset chest pain and was diagnosed with spontaneous coronary artery dissection and needed urgent catheterization revealing left anterior descending coronary artery dissection. She underwent emergent coronary artery bypass graft surgery with good post-operative recovery.
Most patients with PSCAD can be managed conservatively with medical management and have good outcomes. Patients with high-risk presentations benefit from the invasive approach. Coronary artery bypass graft may be required in select few patients based on angiography findings. Due to the risk of recurrent spontaneous coronary artery dissection, subsequent pregnancies are discouraged.
Core Tip: Chest pain during pregnancy and peripartum period need a comprehensive workup. Pregnancy is an isolated risk factor for spontaneous coronary artery dissection. Patients with pregnancy-associated spontaneous coronary artery dissection often have an elevated rate of high-risk presentations and may require invasive treatment or coronary artery bypass graft in few cases. Multidisciplinary care coordinated by a team of experts including interventional cardiologists, high-risk obstetricians, internists, cardiothoracic surgeons and Critical care specialists is essential in managing these patients in the peripartum period. Early diagnosis and timely intervention are lifesaving in cases involving Pregnancy associated spontaneous coronary artery dissection.