# 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.

## Key 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.