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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

Multidisciplinary care for a parturient with Spontaneous coronary artery dissection

Abstract Number: S4D-4
Abstract Type: Case Report/Case Series

Anjum Anwar MD1 ; Kristen Vanderhoef MD2; Fouzia Khalid FCPS3

Introduction:

Spontaneous coronary artery dissection (SCAD) is an infrequent and often missed diagnosis among patients with acute coronary syndrome (ACS) (1).

Pregnancy-associated SCAD is defined as SCAD occurring during pregnancy or within 3 months postpartum (2). Pregnant SCAD patients have more acute presentations and high-risk features than women with non pregnant SCAD (3). Early diagnosis and management is a key to avoid life threatening maternal and fetal complications.

Case Report:

A 35 year old G8P4034 at 35 weeks gestation was transferred from an outside hospital (OH) with constant, substernal chest pain radiating down both arms. She was found to have elevated troponins, and coronary artery dissection was suspected. Chest pain resolved after aspirin administration at the OH. Her past history was significant for gestational diabetes and depression/anxiety. She was admitted to the CCU. An echo from the OH showed an EF of 61% with no abnormalities. EKG was normal and cardiac enzymes had returned to normal. She was continued on aspirin therapy. Coronary angiography as well as catheterization were discussed, but were determined to be too risky during pregnancy in the setting of hemodynamic stability and chest pain resolution. Decision was made to proceed with cesarean delivery while the patient was stable. Due to the possible cardiac complications, the case was performed in the interventional cardiology hybrid operating room, with cardiology and cardiothoracic surgery on stand-by. An arterial line was placed pre-operatively, followed by a spinal anesthetic. The delivery of a viable male infant was uneventful. Post delivery, patient was taken back to the CCU. Repeat cardiac studies were completed and unchanged. No cardiac intervention was necessary. The patient was discharged home on postpartum day 4. Despite imaging not being completed, cardiology believed our patient did in fact have SCAD of a distal vessel.

Conclusion:

SCAD is a major cause of myocardial infarction (MI) in pregnancy and the postpartum period (4). Due to association of SCAD with MI, CHF and sudden cardiac death there should be a low threshold to consider SCAD diagnosis in parturients and postpartum patients with ACS.

References:

1) Yip A, Saw J. Spontaneous coronary artery dissection—a review. Cardiovascular diagnosis and therapy. 2015 Feb;5(1):37.

2) Paratz ED, Kao C, MacIsaac AI, Somaratne J, Whitbourn R. Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review. IJC Heart & Vasculature. 2018 Mar 31;18:1-6.

3) Tweet MS, Hayes SN, Codsi E, Gulati R, Rose CH, Best PJ. Spontaneous coronary artery dissection associated with pregnancy. Journal of the American College of Cardiology. 2017 Jul 25;70(4):426-35.

4) Codsi E, Tweet MS, Rose CH, Arendt KW, Best PJ, Hayes SN. Spontaneous Coronary Artery Dissection in Pregnancy: What Every Obstetrician Should Know. Obstetrics & Gynecology. 2016 Oct 1

SOAP 2018