SHM Converge Scientific Abstract ePoster Gallery-Emotional Stress-Induced Spontaneous Coronary Artery Dissection in a Healthy Postmenopausal Woman: A Rare Case of the Broken Heart

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This document describes spontaneous coronary artery dissection (SCAD), a rare cause of acute coronary syndrome caused by a tear in the coronary artery wall, usually without significant atherosclerosis. SCAD is most often seen in middle-aged women and is associated with factors such as fibromuscular dysplasia, pregnancy, and major emotional or physical stress, though it is still underrecognized and not fully understood.<br /><br />The case involves a healthy 56-year-old postmenopausal woman with no prior medical history who developed intermittent substernal chest pain radiating to the left shoulder after a major emotional stressor related to a custody dispute. In the emergency department, she had elevated blood pressure, high troponin, and an ECG showing ST-segment elevation consistent with acute myocardial infarction. She was initially treated as ACS with aspirin, clopidogrel, and heparin. Coronary angiography later revealed SCAD in the distal left anterior descending artery with preserved but reduced flow and no significant coronary artery disease. Echocardiography showed reduced left ventricular function with apical hypokinesis.<br /><br />She was managed conservatively with dual antiplatelet therapy, losartan, metoprolol, and atorvastatin rather than PCI. Her cardiac function improved during hospitalization, with ejection fraction rising from 40–45% to 52% and resolution of wall motion abnormalities. She was discharged stable with follow-up.<br /><br />The report emphasizes that SCAD should be considered in women, especially postmenopausal patients, who present with ACS symptoms but lack traditional risk factors. Emotional stress and hormonal changes may contribute to vessel fragility and trigger SCAD. Early recognition, cardiology consultation, conservative treatment when appropriate, and multidisciplinary care are important for good outcomes and recurrence prevention.

Asset Subtitle

Jacob Sutton

Meta Tag

Author List Anh Nguyen, Jacob Sutton, Suzanne El Sayegh

Category Clinical Vignettes

Concept Spontaneous Coronary Artery Dissection

Concept Acute Coronary Syndrome

Concept Coronary Angiography

Concept Observation

Concept Myocardial Infarction

Distinguished Non-Finalist

Presenter Organization Northwell Health/Staten Island University Hospital

Presenting Author Jacob Sutton

Track Adult

Keywords

spontaneous coronary artery dissection

SCAD

acute coronary syndrome

myocardial infarction

coronary angiography

postmenopausal woman

emotional stress

dual antiplatelet therapy

left anterior descending artery

conservative management

Spontaneous Coronary Artery Dissection

Acute Coronary Syndrome

Coronary Angiography

Observation

Myocardial Infarction