Recurrent Pregnancy-Associated Spontaneous Coronary Artery Dissection: A Case of STEMI in Both Antenatal and Postpartum Periods

Andrii Labchuk MD; Katarzyna Mikrut MD; Viktoriya Bikeyeva MD; Giovanni Paolella MD

Recurrent Pregnancy-Associated Spontaneous Coronary Artery Dissection: A Case of STEMI in Both Antenatal and Postpartum Periods

Andrii Labchuk MD, Katarzyna Mikrut MD, Viktoriya Bikeyeva MD, Giovanni Paolella MD

Research output: Contribution to conference › Poster › peer-review

Abstract

Introduction/Background:

Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome, primarily affecting young women, often associated with pregnancy and hormonal changes, including in vitro fertilization (IVF). Pregnancy-associated SCAD (P-SCAD) presents diagnostic and management challenges due to physiological cardiovascular adaptations. This case highlights a recurrent SCAD event occurring both antenatally and postpartum, leading to ST-elevation myocardial infarction (STEMI).

Description:

A 38-year-old woman at 34 weeks of gestation via IVF presented with substernal chest pain. Initial ECG was unremarkable, but troponins rose from 191 to 5500. A repeat ECG showed T-wave abnormalities. Given hemodynamic stability, conservative management was initiated. She later developed non-sustained ventricular tachycardia, prompting coronary angiography, which revealed a Type II SCAD in the mid-left anterior descending (LAD) artery with 50% stenosis and TIMI III flow. She was treated with aspirin, labetalol, and nifedipine.

Hours later, she developed hypertensive emergency and pre-eclampsia symptoms with recurrent chest pain. A nitroglycerin infusion was initiated, later switched to labetalol. An urgent cesarean section was performed, after which her chest pain resolved without coronary intervention. She was discharged in stable condition.

In the postpartum period, she re-presented with chest pain and dyspnea. ECG showed an inferior STEMI. Coronary angiography revealed a long Type II SCAD in the right posterior descending artery with TIMI II flow, while the previous LAD SCAD had resolved. Due to inconclusive intravascular ultrasound, she was managed conservatively with an intra-aortic balloon pump, which was removed the following day.

Discussion:

SCAD should be recognized as a potential cause of acute coronary syndrome during pregnancy and postpartum. This case highlights the risk of recurrence in the postpartum period, emphasizing the need for close monitoring. Conservative management remains the first-line approach in stable cases, but individual considerations must guide treatment. Future research should focus on optimizing risk stratification and management strategies for P-SCAD to improve maternal cardiovascular outcomes.

Original language	American English
Status	Published - May 21 2025
Event	Scientific Day 2025 - Advocate Lutheran General Hospital, Park Ridge, United States Duration: May 21 2025 → May 21 2025 https://institutionalrepository.aah.org/sciday/2025/

Conference

Conference	Scientific Day 2025
Country/Territory	United States
City	Park Ridge
Period	5/21/25 → 5/21/25
Internet address	https://institutionalrepository.aah.org/sciday/2025/

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Recurrent Pregnancy-Associated Spontaneous Coronary Artery Dissec

http://institutionalrepository.aah.org/sciday/2025/casereport/15

Cite this

@conference{c4c7a13b8b6a44d9bfa50f44398e42a3,

title = "Recurrent Pregnancy-Associated Spontaneous Coronary Artery Dissection: A Case of STEMI in Both Antenatal and Postpartum Periods",

abstract = "Introduction/Background: Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome, primarily affecting young women, often associated with pregnancy and hormonal changes, including in vitro fertilization (IVF). Pregnancy-associated SCAD (P-SCAD) presents diagnostic and management challenges due to physiological cardiovascular adaptations. This case highlights a recurrent SCAD event occurring both antenatally and postpartum, leading to ST-elevation myocardial infarction (STEMI). Description: A 38-year-old woman at 34 weeks of gestation via IVF presented with substernal chest pain. Initial ECG was unremarkable, but troponins rose from 191 to 5500. A repeat ECG showed T-wave abnormalities. Given hemodynamic stability, conservative management was initiated. She later developed non-sustained ventricular tachycardia, prompting coronary angiography, which revealed a Type II SCAD in the mid-left anterior descending (LAD) artery with 50% stenosis and TIMI III flow. She was treated with aspirin, labetalol, and nifedipine. Hours later, she developed hypertensive emergency and pre-eclampsia symptoms with recurrent chest pain. A nitroglycerin infusion was initiated, later switched to labetalol. An urgent cesarean section was performed, after which her chest pain resolved without coronary intervention. She was discharged in stable condition. In the postpartum period, she re-presented with chest pain and dyspnea. ECG showed an inferior STEMI. Coronary angiography revealed a long Type II SCAD in the right posterior descending artery with TIMI II flow, while the previous LAD SCAD had resolved. Due to inconclusive intravascular ultrasound, she was managed conservatively with an intra-aortic balloon pump, which was removed the following day. Discussion: SCAD should be recognized as a potential cause of acute coronary syndrome during pregnancy and postpartum. This case highlights the risk of recurrence in the postpartum period, emphasizing the need for close monitoring. Conservative management remains the first-line approach in stable cases, but individual considerations must guide treatment. Future research should focus on optimizing risk stratification and management strategies for P-SCAD to improve maternal cardiovascular outcomes.",

author = "MD, {Andrii Labchuk} and MD, {Katarzyna Mikrut} and MD, {Viktoriya Bikeyeva} and MD, {Giovanni Paolella}",

year = "2025",

month = may,

day = "21",

language = "American English",

note = "Scientific Day 2025 ; Conference date: 21-05-2025 Through 21-05-2025",

url = "https://institutionalrepository.aah.org/sciday/2025/",

}

TY - CONF

T1 - Recurrent Pregnancy-Associated Spontaneous Coronary Artery Dissection: A Case of STEMI in Both Antenatal and Postpartum Periods

AU - MD, Andrii Labchuk

AU - MD, Katarzyna Mikrut

AU - MD, Viktoriya Bikeyeva

AU - MD, Giovanni Paolella

PY - 2025/5/21

Y1 - 2025/5/21

N2 - Introduction/Background: Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome, primarily affecting young women, often associated with pregnancy and hormonal changes, including in vitro fertilization (IVF). Pregnancy-associated SCAD (P-SCAD) presents diagnostic and management challenges due to physiological cardiovascular adaptations. This case highlights a recurrent SCAD event occurring both antenatally and postpartum, leading to ST-elevation myocardial infarction (STEMI). Description: A 38-year-old woman at 34 weeks of gestation via IVF presented with substernal chest pain. Initial ECG was unremarkable, but troponins rose from 191 to 5500. A repeat ECG showed T-wave abnormalities. Given hemodynamic stability, conservative management was initiated. She later developed non-sustained ventricular tachycardia, prompting coronary angiography, which revealed a Type II SCAD in the mid-left anterior descending (LAD) artery with 50% stenosis and TIMI III flow. She was treated with aspirin, labetalol, and nifedipine. Hours later, she developed hypertensive emergency and pre-eclampsia symptoms with recurrent chest pain. A nitroglycerin infusion was initiated, later switched to labetalol. An urgent cesarean section was performed, after which her chest pain resolved without coronary intervention. She was discharged in stable condition. In the postpartum period, she re-presented with chest pain and dyspnea. ECG showed an inferior STEMI. Coronary angiography revealed a long Type II SCAD in the right posterior descending artery with TIMI II flow, while the previous LAD SCAD had resolved. Due to inconclusive intravascular ultrasound, she was managed conservatively with an intra-aortic balloon pump, which was removed the following day. Discussion: SCAD should be recognized as a potential cause of acute coronary syndrome during pregnancy and postpartum. This case highlights the risk of recurrence in the postpartum period, emphasizing the need for close monitoring. Conservative management remains the first-line approach in stable cases, but individual considerations must guide treatment. Future research should focus on optimizing risk stratification and management strategies for P-SCAD to improve maternal cardiovascular outcomes.

AB - Introduction/Background: Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome, primarily affecting young women, often associated with pregnancy and hormonal changes, including in vitro fertilization (IVF). Pregnancy-associated SCAD (P-SCAD) presents diagnostic and management challenges due to physiological cardiovascular adaptations. This case highlights a recurrent SCAD event occurring both antenatally and postpartum, leading to ST-elevation myocardial infarction (STEMI). Description: A 38-year-old woman at 34 weeks of gestation via IVF presented with substernal chest pain. Initial ECG was unremarkable, but troponins rose from 191 to 5500. A repeat ECG showed T-wave abnormalities. Given hemodynamic stability, conservative management was initiated. She later developed non-sustained ventricular tachycardia, prompting coronary angiography, which revealed a Type II SCAD in the mid-left anterior descending (LAD) artery with 50% stenosis and TIMI III flow. She was treated with aspirin, labetalol, and nifedipine. Hours later, she developed hypertensive emergency and pre-eclampsia symptoms with recurrent chest pain. A nitroglycerin infusion was initiated, later switched to labetalol. An urgent cesarean section was performed, after which her chest pain resolved without coronary intervention. She was discharged in stable condition. In the postpartum period, she re-presented with chest pain and dyspnea. ECG showed an inferior STEMI. Coronary angiography revealed a long Type II SCAD in the right posterior descending artery with TIMI II flow, while the previous LAD SCAD had resolved. Due to inconclusive intravascular ultrasound, she was managed conservatively with an intra-aortic balloon pump, which was removed the following day. Discussion: SCAD should be recognized as a potential cause of acute coronary syndrome during pregnancy and postpartum. This case highlights the risk of recurrence in the postpartum period, emphasizing the need for close monitoring. Conservative management remains the first-line approach in stable cases, but individual considerations must guide treatment. Future research should focus on optimizing risk stratification and management strategies for P-SCAD to improve maternal cardiovascular outcomes.

M3 - Poster

T2 - Scientific Day 2025

Y2 - 21 May 2025 through 21 May 2025

ER -