SHM Converge Scientific Abstract ePoster Gallery-Acute Coronary Syndrome Due to Type 1 Spontaneous Coronary Artery Dissection in a Young Woman Following Recent Pregnancy Termination

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This case report describes a 30-year-old woman who developed acute coronary syndrome caused by type 1 spontaneous coronary artery dissection (SCAD) shortly after a medical pregnancy termination with mifepristone and misoprostol. SCAD is an important cause of myocardial infarction in women under 50 and is associated with pregnancy, emotional or physical stress, and fibromuscular dysplasia (FMD). Although pregnancy-associated SCAD is well recognized, SCAD after pregnancy termination is uncommon.<br /><br />The patient presented to the emergency department with chest pain. Her initial ECG showed nonspecific ST-T abnormalities, and troponin levels rose markedly from 32 to 5,392. Repeat ECGs demonstrated dynamic changes, including new T-wave inversions in leads III and V2. Bedside ultrasound showed preserved ejection fraction without obvious wall motion abnormalities. Coronary angiography confirmed type 1 SCAD involving the mid-distal left anterior descending artery and the left circumflex/OM1 with preserved distal flow (TIMI 3).<br /><br />She was managed conservatively with metoprolol, a statin, and one month of dual antiplatelet therapy, and she was advised to avoid future pregnancy. Because of the association between SCAD and FMD, further evaluation was performed; abdominal MRA showed a questionable irregularity of the left renal artery without classic beading, and incidental median arcuate ligament syndrome (MALS) was also noted.<br /><br />The report emphasizes that SCAD should be considered in young women with chest pain not only during pregnancy, but also in the peri-pregnancy period, including after termination. Clinicians should maintain a low threshold for serial ECGs, troponin testing, and cardiology consultation. Coronary angiography remains the diagnostic gold standard, and overall prognosis is generally good with appropriate management.

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Sharan J. Kapadia

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Author List Abel Casso Dominguez, Dayita Wable, Deepika Nagliya, Hsiao-Man Chang, Hyunwoo Kim, Matthew Kolansky, Oumaima Outani, Riddhi Patel, Shahe Tchillingirian, Sharan J. Kapadia, Thomas F. Fusillo

Category Clinical Vignettes

Concept Spontaneous Coronary Artery Dissection

Concept Acute Coronary Syndrome

Concept Coronary Angiography

Concept Troponin

Concept Electrocardiogram

Distinguished Non-Finalist

Presenter Organization Mount Sinai Morningside/West

Presenting Author Sharan J. Kapadia

Track Adult

Keywords

spontaneous coronary artery dissection

SCAD

acute coronary syndrome

pregnancy termination

mifepristone

misoprostol

myocardial infarction

fibromuscular dysplasia

coronary angiography

young women chest pain

Spontaneous Coronary Artery Dissection

Acute Coronary Syndrome

Coronary Angiography

Troponin

Electrocardiogram