Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2021; 13(4): 103-110
Published online Apr 26, 2021. doi: 10.4330/wjc.v13.i4.103
Pregnancy associated spontaneous coronary artery dissection: A case report and review of literature
Kalyan Prudhvi, Jayasree Jonnadula, Venkata Ram Pradeep Rokkam, Gurusaravanan Kutti Sridharan
Kalyan Prudhvi, Division of Critical Care Medicine, Mercy Hospital, Saint Louis University School of Medicine, St. Louis, MO 63141, United States
Jayasree Jonnadula, Department of Geriatric Medicine, Barnes Jewish Hospital/Washington University, St. Louis, MO 63110, United States
Venkata Ram Pradeep Rokkam, Gurusaravanan Kutti Sridharan, Division of Inpatient Medicine, University of Arizona/Banner University Medical Center, Tucson, AZ 85719, United States
Author contributions: Prudhvi K, Jonnadula J, Rokkam VRP, Kutti Sridharan G, all four authors equally contributed to this manuscript; all four authors have analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed and written consent obtained from the patient and attached.
Conflict-of-interest statement: The authors disclose no conflicts of interest and the statement attached.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kalyan Prudhvi, MD, Academic Fellow, Division of Critical Care Medicine, Mercy Hospital, Saint Louis University School of Medicine, 625 S. New Ballas Road, Suite 7020, St. Louis, MO 63141, United States. kalyanprudhvi@gmail.com
Received: November 30, 2020
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Pregnancy, Spontaneous artery dissection, Acute coronary syndrome, Coronary artery bypass surgery, Percutaneous coronary intervention, Pregnancy, Dissection, Myocardial Infraction, Case report

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.