Yelixa Santos Roman, MD
Critical Care
Aventura Hospital and Medical Center, United States
Disclosure information not submitted.
Arian Bethencourt Mirabal, MD
MD
Aventura Hospital and Medical Center
MIAMI, Florida, United States
Disclosure information not submitted.
Fernando Castillo, MD
Resident
Kendall Regional
Miami, Florida, United States
Disclosure information not submitted.
Hector Vazquez, MD
Program Director
Aventura Hospital and Medical Center, United States
Disclosure information not submitted.
Sherard Lacaille, MD
Critical Care
Kendall Regional Medical Center
Miami, Florida, United States
Disclosure information not submitted.
Title: A Mother's Pain: Myocardial Infarction with an Uncommon Etiology
Case Report Body:
Introduction: Pregnancy related spontaneous coronary artery dissection (P-SCAD) is a rare complication of pregnancy with a high mortality rate. P-SCAD may be found in less than 5% cases related to spontaneous coronary artery dissection. It occurs around ages 35-40 years old. P-SCAD occurs as earlier as within 2 weeks of pregnancy and 6 weeks postpartum. P-SCAD can present as acute myocardial infarction, congestive heart failure, ventricular arrhythmia and sudden death. Coronaries commonly involved are LM/LAD. Treatment involves PCI, CABG and sometimes mechanical support.
Description: A 37-year-old woman (gravida 1, para 1) presents to the emergency department, after sudden onset of chest pain radiating to the back with associated lightheadedness and near syncope. Patient states symptoms started while breastfeeding her baby which was delivered by cesarean section 7 days ago. No complications during pregnancy or during labor. Upon arrival to the emergency department patient was found hypotensive with tachycardia, not responsive to fluid resuscitation. EKG showed ST elevation in AVR and V1 diffuse ST segment depression in inferior, inferior-lateral and high lateral leads. Initial troponin 1.740 ng/ml. No STEMI criteria. Chest CTA negative for pulmonary embolism and aortic dissection. Cardiology consulted, in view of EKG changes suggestive of STEMI equivalent and shock status, STEMI alert was activated. Cardiac catheterization showed distal LM dissection with 90% occlusion and proximal LAD occlusion 90% and EF 35%. Two Drug eluting stents were placed along with Impella CP device. Patient treated with medical therapy DAPT, Impella was removed in day 3. EF recovered 50% and was successfully discharge.
Discussion: P-SCAD is a rare complication of pregnancy with a mortality rate associated 38%-50%. This case highlights the importance of early recognition and clinical expertise to recognized P-SCAD despite not having classic STEMI presentation. Early detection is associated with better survival rates.