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Case Report
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| Postpartum spontaneous coronary artery dissection: A rare occurrence | ||||||
| Juan Roa Mendez1, Jenny Gerner2, Kimberly Andrews-Reynolds3, Lekshmi Dharmarajan4 | ||||||
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1PGY2, Internal Medicine, Lincoln Medical and Mental Health Center, Bronx, New York, USA.
2PGY3, Internal Medicine, Lincoln Medical and Mental Health Center, Bronx, New York, USA. 3Research Assistant, Internal Medicine, Lincoln Medical and Mental Health Center, Bronx, New York, USA. 4MD, Cardiology Attending, FACP, FACC, Internal Medicine, Lincoln Medical and Mental Health Center, Bronx, New York, USA. | ||||||
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| How to cite this article: |
| Mendez JR, Gerner J, Andrews-Reynolds K, Dharmarajan L. Postpartum spontaneous coronary artery dissection: A rare occurrence. International Journal of Case Reports and Images 2012;3(11):21–24. |
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Abstract
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Introduction:
Postpartum spontaneous coronary artery dissection is a rare but well described presentation of acute coronary syndrome. Acute phase mortality is 5–10%. The majority of dissections occur within two weeks postpartum. Risk factors include advanced age, multiparity, hormonal changes, activities that increase coronary shear stress and hemodynamic factors such as hypertension, cocaine use and weight lifting. Dissections typically involve proximal segment of coronary arteries. Angiographic studies confirm etiology of postpartum MI to be: dissection 35%, stenosis 30%, thrombus 15%, spasm <5%, and 10% with normal coronaries.
Case Report: A 30-year-old female, 10 days postpartum presented with recurrent oppressive retro-sternal chest pain, radiating to left arm and back, with orthopnea and vomiting. She reported lifting weights the day prior to admission. Apart from elevated blood pressure, physical examination was otherwise unremarkable. Diagnosis of spontaneous coronary artery dissection was confirmed through laboratory and radiographic testing which showed elevated cardiac enzymes and both an abnormal echocardiogram and angiogram, respectively. Patient was managed medically due to difficult anatomy for percutaneous coronary intervention. Conclusion: SCAD is a rare life threatening condition that affects predominantly young, healthy women, particularly during pregnancy or postpartum period. The pathogenesis is still unclear. The mechanism, however, is increased shear stress in the coronaries by severe systolic hypertension, cocaine use, activities such as snow shoveling, weight lifting. Contributing factors in our young patient with dissection causing acute MI may have resulted from: lifting weights a day earlier, underlying CAD, parity and typical age/time frame for postpartum dissection. | |
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Key Words:
Spontaneous coronary artery dissection, Postpartum, SCAD
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Author Contributions:
Juan Roa Mendez – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Jenny Gerner – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Kimberly Andrews-Reynolds – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Lekshmi Dharmarajan – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission:
The corresponding author is the guarantor of submission. |
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Source of support:
None |
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Conflict of interest:
Authors declare no conflict of interest. |
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Copyright:
© Juan Roa Mendez et al. 2012; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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