Abstract
Pregnancy-associated spontaneous coronary artery dissection (PASCAD) accounts for less than 5% of spontaneous coronary artery dissection cases and is comparatively more fulminant or clinically aggressive. Several factors associated with PASCAD include black ethnicity, multiparity, hypertension, advanced maternal age, and age at first childbirth. This atypical case highlights a preeclamptic patient presenting with an ST-segment elevation myocardial infarction in which multivessel dissection of both the left anterior descending and right coronary arteries were deemed co-culprit lesions for the index event.
Highlights
Spontaneous coronary artery dissection (SCAD) is rapidly gaining traction as an emerging but often neglected cause of myocardial infarction, especially in young women.[1]
The preceding reports of SCAD prevalence on coronary angiography of 0.2% to 1.1% vastly underestimated its true prevalence with the pregnancy-associated SCAD (PASCAD) type affecting almost 2 per 100 000 pregnancies.[6,7,8]
This atypical case highlights a preeclamptic patient presenting with an ST-segment elevation myocardial infarction in which multivessel dissection of both the left anterior descending (LAD) artery and right coronary artery (RCA) were deemed co-culprit lesions for the index event
Summary
Spontaneous coronary artery dissection (SCAD) is rapidly gaining traction as an emerging but often neglected cause of myocardial infarction, especially in young women.[1]. The preceding reports of SCAD prevalence on coronary angiography of 0.2% to 1.1% vastly underestimated its true prevalence with the PASCAD type affecting almost 2 per 100 000 pregnancies.[6,7,8] This atypical case highlights a preeclamptic patient presenting with an ST-segment elevation myocardial infarction in which multivessel dissection of both the left anterior descending (LAD) artery and right coronary artery (RCA) were deemed co-culprit lesions for the index event. A predischarge transthoracic echocardiogram displayed normalization of ejection fraction from 60% to 65% amid steadily declining cardiac biomarkers Her angina and dyspnea resolved over the ensuing course, and she was subsequently discharged on guideline-directed medical therapy with an early outpatient clinic appointment to both cardiology and the high-risk obstetrical unit. She successfully underwent vaginal delivery 6 weeks later without any maternal or fetal complications and was extensively counseled against further pregnancy with which she was in consensus
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