McGovern Laurna, Coughlan J J, Murphy Ross, Edroos Sadat
Department of Cardiology, St. James's Hospital, Dublin, Ireland.
Eur Heart J Case Rep. 2020 Dec 22;5(1):ytaa455. doi: 10.1093/ehjcr/ytaa455. eCollection 2021 Jan.
Spontaneous coronary artery dissection (SCAD) is a recognized cause of acute coronary syndrome (ACS). Pregnancy, the postpartum period, and illicit drug use have all been reported as potential triggers.
We describe the case of a 41-year-old patient who presented to the emergency department with chest pain in the setting of recent cocaine and amphetamine use. The patient was 4 months postpartum following an uncomplicated pregnancy. Past medical history was non-contributory, with no known risk factors for ischaemic heart disease. Electrocardiogram was normal but high-sensitivity troponin T was significantly elevated. Coronary angiography revealed multi-vessel SCAD. This was managed conservatively as the patient remained clinically stable and pain free without high-risk anatomy (left main stem or proximal two-vessel coronary artery dissection).
Spontaneous coronary artery dissection must be considered in a postpartum patient presenting with ACS, particularly in the context of environmental stressors such as illicit drug use. Coronary angiography is key to determine diagnosis and guide management. Conservative therapy is favoured, except for patients with ongoing ischaemia, haemodynamic instability, and left main stem involvement. In this case, we suspect SCAD occurred due to the haemodynamic effects of cocaine and amphetamines in the context of structural arterial changes of the postpartum state.
自发性冠状动脉夹层（SCAD）是急性冠状动脉综合征（ACS）的一种公认病因。妊娠、产后时期及非法药物使用均已被报道为潜在诱因。
我们描述了一名41岁患者的病例，该患者在近期使用可卡因和苯丙胺后因胸痛就诊于急诊科。患者在经历一次无并发症的妊娠后处于产后4个月。既往病史无特殊，无已知的缺血性心脏病危险因素。心电图正常，但高敏肌钙蛋白T显著升高。冠状动脉造影显示多支血管发生SCAD。由于患者临床情况稳定且无疼痛，不存在高危解剖结构（左主干或近端双支冠状动脉夹层），故采取保守治疗。
对于出现ACS的产后患者，尤其是在存在非法药物使用等环境应激因素的情况下，必须考虑自发性冠状动脉夹层。冠状动脉造影是确定诊断和指导治疗的关键。除了有持续性缺血、血流动力学不稳定和左主干受累的患者外，保守治疗是首选。在本病例中，我们怀疑SCAD是由于产后状态下动脉结构改变的情况下，可卡因和苯丙胺的血流动力学效应所致。
