SHM Converge Scientific Abstract ePoster Gallery-Chest Pain in a Young Woman-a Diagnostic and Management Dilemma

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This case highlights the importance of early recognition of spontaneous coronary artery dissection (SCAD), a rare but serious cause of acute coronary syndrome, especially in young women with few traditional cardiac risk factors.<br /><br />A 19-year-old woman with a history of hypertension, diabetes, obesity, tobacco and marijuana use, and medication noncompliance presented with 24 hours of substernal, pressure-like chest pain radiating to the right arm and between the shoulder blades. Her symptoms were associated with shortness of breath and palpitations and were preceded by alcohol use. On exam, she was tachycardic but otherwise hemodynamically stable.<br /><br />Evaluation showed ST-T elevation in the anteroseptal and lateral leads with Q waves in V1 and V2, elevated troponin, severe hyperglycemia with diabetic ketoacidosis features, and leukocytosis. Cardiac catheterization revealed 100% ostial occlusion of the LAD. Attempts at wire passage and balloon angioplasty were unsuccessful, raising concern for a false lumen. Intravascular ultrasound demonstrated mild atherosclerosis and an almost completely occlusive dissection flap, confirming high suspicion for SCAD. An intra-aortic balloon pump was placed, and echocardiography showed severely reduced ejection fraction (21–25%) with apical and septal akinesis. CT surgery was consulted, but the patient was managed conservatively. She improved over two weeks and was discharged with cardiac rehabilitation and cardiology follow-up. One month later, repeat echocardiography showed improved EF (36–40%).<br /><br />The case underscores that SCAD should be considered in young women presenting with ACS, even when classic risk factors are absent. Prompt diagnosis, careful angiographic interpretation, and early multidisciplinary management are essential to reduce morbidity and mortality. Hospitalists play a key role in maintaining a high index of suspicion and ensuring timely cardiology and surgical involvement.

Asset Subtitle

Kushal B. Baniya

Meta Tag

Author List Arati K C, Kushal B. Baniya

Category Clinical Vignettes

Concept Spontaneous Coronary Artery Dissection

Concept Acute Coronary Syndrome

Concept Coronary Angiography

Concept Chest Pain

Concept Intravascular Ultrasound

Distinguished Non-Finalist

Presenter Organization Ocean University Medical Center

Presenting Author Kushal B. Baniya

Track Adult

Keywords

spontaneous coronary artery dissection

SCAD

acute coronary syndrome

young women

left anterior descending artery

myocardial infarction

intravascular ultrasound

coronary angiography

cardiogenic support

cardiac rehabilitation

Spontaneous Coronary Artery Dissection

Acute Coronary Syndrome

Coronary Angiography

Chest Pain

Intravascular Ultrasound