Spontaneous left main stem coronary artery dissection in a young postpartum woman

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Spontaneous coronary artery dissection (SCAD) is a rare disorder described in the literature.1 Its prevalence is estimated to range between 0.1 and 0.28% of all the acute coronary syndromes.2 It generally occurs more often in women during the postpartum period within the first 2 weeks after delivery.3
We describe the case of a 38-year-old woman admitted to our emergency room with acute chest pain. She was breastfeeding (eighth week after delivery) and her medical history was unremarkable. The ECG showed inferolateral ST depression (Fig. 1). Blood pressure was 80/50 mmHg. An echocardiogram revealed mild left ventricular dysfunction (ejection fraction 40%) and apex akinesis. An urgent coronary angiography revealed a spontaneous and flow-limiting distal left main stem (LMS) coronary artery dissection (Fig. 2). The patient was successfully treated with percutaneous coronary intervention and implantation of multiple drug-eluting stents (Fig. 3a). At 9-month follow-up, she remained asymptomatic with a good long-term angiographic result (Fig. 3b).
Hypotheses regarding the mechanism of SCAD during pregnancy are related to the changes in the composition of the medial layer of arteries and the coagulative cascade function.4 The LMS localization is a very rare and life-threatening condition5 often diagnosed post-mortem. SCAD should be considered even in the late postpartum period.

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