SHM Converge Scientific Abstract ePoster Gallery-Pregnancy-Associated Spontaneous Coronary Artery Dissection: A Case Report and Comprehensive Discussion

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This case report describes a 22-year-old woman who developed spontaneous coronary artery dissection (SCAD) two weeks after delivering her first child. She presented with three days of intermittent sharp left-sided chest pain radiating to the left arm. Her vital signs were stable, but coronary angiography showed near-complete occlusion of the OM1 branch from the left circumflex artery, consistent with SCAD, while the remaining coronary arteries were normal.<br /><br />Because of the vessel’s small size and location, the team chose conservative management rather than stenting. Her chest pain resolved during hospitalization, and she was discharged the next day in stable condition. Although medications such as clopidogrel, atorvastatin, and a beta-blocker were initially considered, none were started because she was breastfeeding and had no history of atherosclerotic, hypertensive, or cardiac disease. At four-week follow-up, she remained symptom-free.<br /><br />The review highlights that SCAD is a non-traumatic, non-iatrogenic coronary artery wall separation that is especially common in women and can occur during pregnancy or the postpartum period. P-SCAD may account for up to 17% of SCAD cases. The condition causes intramural hematoma and compression of the true lumen, leading to myocardial ischemia. The most commonly affected artery is the left anterior descending artery, though any coronary vessel may be involved.<br /><br />Management is individualized. Heparin is stopped once SCAD is diagnosed, beta-blockers may reduce recurrence risk, and antiplatelet therapy is often used in non-PCI cases. Statin use remains controversial because SCAD is usually not caused by atherosclerosis. The authors emphasize maintaining a high index of suspicion for SCAD in young postpartum women with chest pain and tailoring treatment to breastfeeding status and other patient-specific factors.

Asset Subtitle

Jay Patel

Meta Tag

Author List Anil Anumandla, Jay Patel, Paul Watanakunakorn, Samantha Limvalencia, Shiva Verma

Category Clinical Vignettes

Concept Spontaneous Coronary Artery Dissection

Concept Intramural Hematoma

Concept Pregnancy-Associated Spontaneous Coronary Artery Dissection

Concept Type 4 SCAD

Concept True Lumen Compression

Distinguished Non-Finalist

Presenter Organization Sierra View Medical Center

Presenting Author Jay Patel

Track Adult

Keywords

spontaneous coronary artery dissection

SCAD

postpartum

chest pain

young woman

coronary angiography

left circumflex artery

conservative management

breastfeeding

myocardial ischemia

Spontaneous Coronary Artery Dissection

Intramural Hematoma

Pregnancy-Associated Spontaneous Coronary Artery Dissection

Type 4 SCAD

True Lumen Compression