Prudhvi Kalyan, Jonnadula Jayasree, Rokkam Venkata Ram Pradeep, Kutti Sridharan Gurusaravanan
Division of Critical Care Medicine, Mercy Hospital, Saint Louis University School of Medicine, St. Louis, MO 63141, United States.
Department of Geriatric Medicine, Barnes Jewish Hospital/Washington University, St. Louis, MO 63110, United States.
World J Cardiol. 2021 Apr 26;13(4):103-110. doi: 10.4330/wjc.v13.i4.103.
Pregnancy-associated spontaneous coronary artery dissection (PSCAD) is an important cause of chest pain and acute myocardial infarction in pregnant and postpartum women. Pregnancy is considered an isolated risk factor for spontaneous coronary artery dissection. The etiology, pathogenesis, and incidence of PSCAD are not known.
We present a case of a 33-year-old postpartum female who presented with sudden onset chest pain and was diagnosed with spontaneous coronary artery dissection and needed urgent catheterization revealing left anterior descending coronary artery dissection. She underwent emergent coronary artery bypass graft surgery with good post-operative recovery.
Most patients with PSCAD can be managed conservatively with medical management and have good outcomes. Patients with high-risk presentations benefit from the invasive approach. Coronary artery bypass graft may be required in select few patients based on angiography findings. Due to the risk of recurrent spontaneous coronary artery dissection, subsequent pregnancies are discouraged.
妊娠相关自发性冠状动脉夹层（PSCAD）是孕妇和产后女性胸痛及急性心肌梗死的重要原因。妊娠被认为是自发性冠状动脉夹层的独立危险因素。PSCAD的病因、发病机制和发病率尚不清楚。
我们报告一例33岁产后女性，突发胸痛，诊断为自发性冠状动脉夹层，需紧急行心导管检查，显示左前降支冠状动脉夹层。她接受了急诊冠状动脉搭桥手术，术后恢复良好。
大多数PSCAD患者可通过药物治疗进行保守管理，预后良好。高危表现的患者从侵入性治疗方法中获益。根据血管造影结果，少数患者可能需要进行冠状动脉搭桥手术。由于存在复发性自发性冠状动脉夹层的风险，不建议随后再次怀孕。
