Recommended Citation
Labchuk A, Mikrut K, Bikeyeva V, Paolella G. Recurrent Pregnancy-Associated Spontaneous Coronary Artery Dissection: A Case of STEMI in Both Antenatal and Postpartum Periods. Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Abstract
Introduction/Background:
Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome, primarily affecting young women, often associated with pregnancy and hormonal changes, including in vitro fertilization (IVF). Pregnancy-associated SCAD (P-SCAD) presents diagnostic and management challenges due to physiological cardiovascular adaptations. This case highlights a recurrent SCAD event occurring both antenatally and postpartum, leading to ST-elevation myocardial infarction (STEMI).
Description:
A 38-year-old woman at 34 weeks of gestation via IVF presented with substernal chest pain. Initial ECG was unremarkable, but troponins rose from 191 to 5500. A repeat ECG showed T-wave abnormalities. Given hemodynamic stability, conservative management was initiated. She later developed non-sustained ventricular tachycardia, prompting coronary angiography, which revealed a Type II SCAD in the mid-left anterior descending (LAD) artery with 50% stenosis and TIMI III flow. She was treated with aspirin, labetalol, and nifedipine.
Hours later, she developed hypertensive emergency and pre-eclampsia symptoms with recurrent chest pain. A nitroglycerin infusion was initiated, later switched to labetalol. An urgent cesarean section was performed, after which her chest pain resolved without coronary intervention. She was discharged in stable condition.
In the postpartum period, she re-presented with chest pain and dyspnea. ECG showed an inferior STEMI. Coronary angiography revealed a long Type II SCAD in the right posterior descending artery with TIMI II flow, while the previous LAD SCAD had resolved. Due to inconclusive intravascular ultrasound, she was managed conservatively with an intra-aortic balloon pump, which was removed the following day.
Discussion:
SCAD should be recognized as a potential cause of acute coronary syndrome during pregnancy and postpartum. This case highlights the risk of recurrence in the postpartum period, emphasizing the need for close monitoring. Conservative management remains the first-line approach in stable cases, but individual considerations must guide treatment. Future research should focus on optimizing risk stratification and management strategies for P-SCAD to improve maternal cardiovascular outcomes.
Presentation Notes
Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Full Text of Presentation
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Document Type
Poster
Recurrent Pregnancy-Associated Spontaneous Coronary Artery Dissection: A Case of STEMI in Both Antenatal and Postpartum Periods
Introduction/Background:
Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome, primarily affecting young women, often associated with pregnancy and hormonal changes, including in vitro fertilization (IVF). Pregnancy-associated SCAD (P-SCAD) presents diagnostic and management challenges due to physiological cardiovascular adaptations. This case highlights a recurrent SCAD event occurring both antenatally and postpartum, leading to ST-elevation myocardial infarction (STEMI).
Description:
A 38-year-old woman at 34 weeks of gestation via IVF presented with substernal chest pain. Initial ECG was unremarkable, but troponins rose from 191 to 5500. A repeat ECG showed T-wave abnormalities. Given hemodynamic stability, conservative management was initiated. She later developed non-sustained ventricular tachycardia, prompting coronary angiography, which revealed a Type II SCAD in the mid-left anterior descending (LAD) artery with 50% stenosis and TIMI III flow. She was treated with aspirin, labetalol, and nifedipine.
Hours later, she developed hypertensive emergency and pre-eclampsia symptoms with recurrent chest pain. A nitroglycerin infusion was initiated, later switched to labetalol. An urgent cesarean section was performed, after which her chest pain resolved without coronary intervention. She was discharged in stable condition.
In the postpartum period, she re-presented with chest pain and dyspnea. ECG showed an inferior STEMI. Coronary angiography revealed a long Type II SCAD in the right posterior descending artery with TIMI II flow, while the previous LAD SCAD had resolved. Due to inconclusive intravascular ultrasound, she was managed conservatively with an intra-aortic balloon pump, which was removed the following day.
Discussion:
SCAD should be recognized as a potential cause of acute coronary syndrome during pregnancy and postpartum. This case highlights the risk of recurrence in the postpartum period, emphasizing the need for close monitoring. Conservative management remains the first-line approach in stable cases, but individual considerations must guide treatment. Future research should focus on optimizing risk stratification and management strategies for P-SCAD to improve maternal cardiovascular outcomes.
Affiliations
Advocate Lutheran General Hospital