Pregnancy-Associated Spontaneous Coronary Artery Dissection in a Young Prepartum Female Patient
A 32-year-old pregnant (G9P4) African-American woman at 38 weeks of gestation presented with acute-onset substernal chest pain radiating to her left shoulder, accompanied by dyspnea and diaphoresis. Her past medical history was significant for well-controlled bronchial asthma. She was hemodynamically stable at the time of her presentation. Her initial 12-lead electrocardiogram demonstrated anterior ST-segment elevation (Figure 1). Bedside echocardiography in the emergency department revealed hypokinesis in the mid- to distal-anterior, distal septal, and apical walls of the left ventricle, with an ejection fraction of 30-35% (Video 1). She was started on aspirin, a statin, nitroglycerin, and intravenous unfractionated heparin. After emergent consultation from obstetrics, cardiothoracic surgery, and pediatrics, a decision was made to take her for coronary angiography. Angiography revealed spontaneous coronary artery dissection involving the mid-portion of the left anterior descending artery (LAD) with a large intramural hematoma extending from the proximal third of the LAD and sparing of the distal portion of the artery, which had Thrombolysis in Myocardial Infarction-3 flow (Videos 2-3).
Figure 1: 12-L Electrocardiogram on Admission Showing ST-segment Elevation in Anterior Precordial Leads
Video 2: Coronary Angiogram on Admission
Video 3: Coronary Angiogram on Admission
Which one of the following statements is correct regarding the best management option for this patient?