Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2024; 14(01): e34-e39
DOI: 10.1055/s-0043-1778112
Case Report

Bicoastal Spontaneous Coronary Artery Dissection: A Therapeutic Dilemma

Ann B. Nguyen Pham 
1   Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California
,
Madushka Y. De Zoysa 
2   Department of Maternal-Fetal Medicine, University of California, Irvine, Orange, California
,
Brian B. Ghoshhajra
3   Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
,
Nandita S. Scott
4   Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
,
Afshan B. Hameed
2   Department of Maternal-Fetal Medicine, University of California, Irvine, Orange, California
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Due to the potential for severe maternal morbidity and even mortality, pregnancy-associated spontaneous coronary artery dissection (P-SCAD) often presents as a clinical conundrum. While current recommendations encourage coronary interventions when medically indicated even during pregnancy, the hesitation still understandably exists. Meanwhile, given the rarity of the condition, the guidelines for management are still based on expert consensus.

We present a case of P-SCAD in a 38-year-old woman with initial presentation at 28 weeks' gestation and recurrence at 9 days postpartum. A unique complication of this case is its transcontinental nature: the initial event occurred while the patient was on vacation across the country from her home. Questions arose not only with regard to her immediate management and care but also when she would be able to travel and how her complex care would be continued cross-country.

This case raised important questions regarding the antepartum management of acute coronary syndrome (ACS). It also highlights the importance of multidisciplinary care, especially with a cardio-obstetrics team, in the management of P-SCAD and emphasizes the role for universal screening for cardiac diseases in pregnancy.

Keywords - pregnancy - spontaneous coronary artery dissection - pregnancy-associated SCAD

Disclosures

Dr. Scott receives support from the HOPE and REBIRTH study.




Publication History

Received: 16 September 2023

Accepted: 19 October 2023

Article published online:
23 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kim ESH. Spontaneous coronary-artery dissection. N Engl J Med 2020; 383 (24) 2358-2370
    CrossrefPubMedGoogle Scholar
  • 2 Havakuk O, Goland S, Mehra A, Elkayam U. Pregnancy and the risk of spontaneous coronary artery dissection. Circ Cardiovasc Interv 2017; 10 (03) e004941
    CrossrefPubMedGoogle Scholar
  • 3 Hayes SN, Kim ESH, Saw J. et al; American Heart Association Council on Peripheral Vascular Disease; Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Genomic and Precision Medicine; and Stroke Council. Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association. Circulation 2018; 137 (19) e523-e557
    CrossrefPubMedGoogle Scholar
  • 4 Sherman-Brown A, Hameed AB. Cardiovascular disease screening in pregnancy. Clin Obstet Gynecol 2020; 63 (04) 808-814
    CrossrefPubMedGoogle Scholar
  • 5 Tweet MS, Eleid MF, Best PJM. et al. Spontaneous coronary artery dissection: revascularization versus conservative therapy. Circ Cardiovasc Interv 2014; 7 (06) 777-786
    CrossrefPubMedGoogle Scholar
  • 6 Paratz E, Kao C, MacIsaac A, Somaratne J. Evolving management and improving outcomes in pregnancy-associated spontaneous coronary artery dissection (P-SCAD) systematic review. Heart Lung Circ 2017; 26 DOI: 10.1016/j.hlc.2017.06.079.
    CrossrefPubMedGoogle Scholar
  • 7 Elkayam U, Havakuk O. Pregnancy-associated coronary artery dissection: a therapeutic dilemma. J Am Coll Cardiol 2018; 71 (04) 469-470
    CrossrefPubMedGoogle Scholar
  • 8 Hayes SN, Tweet MS, Adlam D. et al. Spontaneous coronary artery dissection. J Am Coll Cardiol 2020; 76 (08) 961-984
    CrossrefPubMedGoogle Scholar
  • 9 O'Kelly AC, Ludmir J, Wood MJ. Acute coronary syndrome in pregnancy and the post-partum period. J Cardiovasc Dev Dis 2022; 9 (07) 198
    PubMedGoogle Scholar
  • 10 Habashi JP, MacFarlane EG, Bagirzadeh R. et al. Oxytocin antagonism prevents pregnancy-associated aortic dissection in a mouse model of Marfan syndrome. Sci Transl Med 2019; 11 (490) eaat4822
    CrossrefPubMedGoogle Scholar
  • 11 Zahger D, Leibowitz D, Tabb IK, Weiss AT. Long-distance air travel soon after an acute coronary syndrome: a prospective evaluation of a triage protocol. Am Heart J 2000; 140 (02) 241-242
    CrossrefPubMedGoogle Scholar