Subsequent Pregnancy in a Patient With Spontaneous Coronary Artery Dissection

Abstract

Spontaneous coronary artery dissection (SCAD) is an exceedingly rare condition that primarily affects women in late pregnancy and post partum period. While rare, the mortality in the acute episode may approach 38%. In the literature there are several reports of SCAD in pregnancy and the post partum period but none describe the management of such patients in a subsequent pregnancy. We report a case of SCAD in the post partum period requiring coronary intervention with placement of four stents. The patient presents for prenatal care for a subsequent unplanned but desired pregnancy. Multidisciplinary care was instituted, including close cardiology follow-up. She remained asymptomatic throughout the pregnancy and post partum period. SCAD as a rare cause of acute coronary syndrome carries a significant mortality especially if there is a delay in diagnosis, and management. It should be an important part of the differential diagnoses for a clinician working up a female patient with chest pain in late pregnancy and post partum period. While our patient had a favorable outcome during the subsequent pregnancy, delivery and post partum periods, close follow-up and co-management with cardiology is important in the care of such patients. Given the lack of available clinical information, management recommendations are suggested using expert opinion and tangential data.




J Clin Gynecol Obstet. 2015;4(1):177-178
doi: http://dx.doi.org/10.14740/jcgo244w