885 Spontaneous Coronary Artery Dissection

Abstract

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of Acute Coronary Syndrome (ACS). Predisposing factors include fibromuscular dysplasia, connective tissue disease and systemic inflammatory conditions. There is predilection to female sex. Pregnancy associated (p-SCAD) has the worst clinical outcome- the cause of which is not entirely understood. We describe the case of a 34-year-old woman, at 14 weeks of pregnancy, who presented to Emergency Department with sudden onset of central chest pain and shortness of breath. No preceding triggers or cardiovascular risk factors were identified. ECG showed anterolateral ST segment elevation and she was haemodynamically unstable. She underwent emergency Coronary Angiogram that revealed SCAD of left main coronary artery (LMCA) / proximal left anterior descending artery (LAD) with TIMI flow 0. Percutaneous coronary intervention restored TIMI 3 flow. At 38+3 weeks she had an elective Caesarean section and underwent permanent contraception with bilateral salpingectomy. Our case is interesting as due to clinical instability, compromised haemodynamics and involvement of distal LMCA/ proximal LAD, intervention was preferred over conservative approach. Appropriate interventional strategies helped overcome technical difficulties and avoid complications. We addressed the use of pharmacy during pregnancy and lactation. Fortunately, she had no complications due to interruption of dual anti-platelet therapy at time of Caesarean section and pro-thrombotic post-partum period. She has minimal risk for p-SCAD recurrence due to permanent contraception. Our case highlights SCAD as an important differential in young women presenting with chest pain; early recognition is imperative as treatment differs from ACS.