Spontaneous coronary artery dissection in a patient with a progestin-releasing intrauterine device

TL;DR

A woman with a progestin-releasing IUD experienced a rare heart condition called SCAD, which was managed without surgery.

Contribution

This case report links SCAD to a progestin-releasing IUD as a potential hormonal trigger.

Findings

The patient had ST-elevation myocardial infarction due to type 1 SCAD in the right coronary artery.

Conservative treatment with antithrombotics and blood pressure control led to favorable outcomes.

The IUD was removed due to its potential role in triggering the condition.

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), which predominantly affects women. This case report describes a 55-year-old female with SCAD potentially linked to a progestin-releasing intrauterine device (IUD) placed 1.5 years ago. The patient presented with acute chest pain and diaphoresis, and was eventually found to have ST-elevation myocardial infarction that led to coronary angiography, revealing type 1 SCAD from the proximal right coronary artery (RCA) to the mid-RCA with grade 3 thrombolysis in myocardial infarction (TIMI) flow distally. She was managed conservatively with antithrombotics, statins, and blood pressure control, achieving favorable outcomes without invasive intervention. The IUD was removed due to its potential role as a hormonal trigger. This case underscores the importance of considering SCAD in women presenting with ACS, particularly in those with hormonal risk factors.

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