Published in:European Heart Journal - Case Reports
Language:
English
DOI:
10.1093/ehjcr/ytae204
ISSN:
2514-2119
Origination:
Footnote:
Description:
<jats:title>Abstract</jats:title>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>One of the main causes of myocardial infarction during pregnancy is spontaneous coronary artery dissection. This is ascribed to hormonal changes during pregnancy leading to a weakening of the vessel wall and hemodynamic changes especially during childbirth. Management options include conservative medical treatment and percutaneous coronary intervention, depending on clinical presentation. In this educational case report we highlight the diagnostic and therapeutic challenges when treating this special patient cohort and the importance of cardiovascular imaging.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Case summary</jats:title>
<jats:p>A 37-year-old woman presented with typical chest pain six weeks after giving birth to her third child. Echocardiography revealed a moderate reduction in systolic function. Initial invasive coronary angiography showed no abnormalities. After cardiac magnetic resonance demonstrated extensive scar, invasive coronary angiography was repeated including intravascular imaging. A dissection of the left anterior descending artery was visualized and treated by percutaneous coronary intervention and stenting. Left ventricular function was normalized at three-month follow-up.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Discussion</jats:title>
<jats:p>Pregnancy-associated spontaneous coronary dissection is a potential differential diagnosis when treating postpartum women with recent onset chest pain. Management is challenging and intravascular imaging to visualize dissection should be performed during invasive coronary angiography. Patients require interdisciplinary care within a pregnancy heart team.</jats:p>
</jats:sec>