Spontaneous pregnancy-associated coronary artery dissection: a case report on diagnostic and therapeutic challenges

TL;DR

A postpartum woman experienced chest pain due to a rare heart condition, requiring advanced imaging and specialized care for diagnosis and treatment.

Contribution

This case report highlights the use of intravascular imaging during angiography for diagnosing and managing pregnancy-associated coronary artery dissection.

Findings

Intravascular imaging confirmed a dissection in the left anterior descending artery after initial angiography showed no abnormalities.

Percutaneous coronary intervention and stenting successfully treated the dissection and normalized heart function within three months.

Interdisciplinary care is essential for managing pregnancy-associated coronary dissection.

Abstract

One of the main causes of myocardial infarction during pregnancy is spontaneous coronary artery dissection. This is ascribed to hormonal changes during pregnancy leading to a weakening of the vessel wall and haemodynamic changes especially during childbirth. Management options include conservative medical treatment and percutaneous coronary intervention, depending on clinical presentation.

A 37-year-old woman presented with typical chest pain six weeks after giving birth to her third child. Echocardiography revealed a moderate reduction in systolic function. Initial invasive coronary angiography showed no abnormalities. After cardiac magnetic resonance demonstrated extensive scar, invasive coronary angiography was repeated including intravascular imaging. A dissection of the left anterior descending artery was visualized and treated by percutaneous coronary intervention and stenting. Left ventricular function was normalized at three-month follow-up. In this educational case report, we highlight the diagnostic and therapeutic challenges when treating this special patient cohort and the importance of cardiovascular imaging.

Pregnancy-associated spontaneous coronary dissection is a potential differential diagnosis when treating post-partum women with recent onset chest pain. Management is challenging and intravascular imaging to visualize dissection should be performed during invasive coronary angiography. Patients require interdisciplinary care within a pregnancy heart team.

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