Rivera Angelica, Plumber Noorine, Louis Mena, Grabill Nathaniel, Strom Pricilla
Northeast Georgia Medical Center, General Surgery Department, 743 Spring Street NE, Gainesville, GA 30501, United States of America.
Northeast Georgia Medical Center, General Surgery Department, 743 Spring Street NE, Gainesville, GA 30501, United States of America.
Int J Surg Case Rep. 2025 Jan;126:110644. doi: 10.1016/j.ijscr.2024.110644. Epub 2024 Nov 24.
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome, predominantly affecting women without traditional cardiovascular risk factors. It is often underdiagnosed, especially in postoperative patients, due to its atypical presentation and the challenges in distinguishing it from other causes of chest pain.
We report the case of a 62-year-old woman with type 2 diabetes mellitus, hypertension, hyperlipidemia, and recent bilateral mastectomy for invasive ductal carcinoma, who presented three days post-surgery with sudden onset of chest pain radiating to her left arm. Electrocardiography revealed ST-segment depression suggestive of anterior ischemia, and cardiac biomarkers were significantly elevated. Imaging studies were limited due to recent surgery, but urgent coronary angiography identified spontaneous coronary artery dissections.
This case highlights the potential role of surgical stress as a precipitating factor for SCAD in patients without traditional cardiovascular risk factors. The physiological stress of major surgery may contribute to arterial wall vulnerability and dissection. Diagnostic challenges in the postoperative setting necessitate a high index of suspicion for timely identification. Conservative management was pursued, aligning with current guidelines that favor non-invasive treatment in stable SCAD cases to prevent further dissection or complications.
SCAD should be considered in the differential diagnosis of acute coronary syndrome in postoperative patients presenting with chest pain, even in the absence of significant cardiovascular risk factors. Early recognition and appropriate management are crucial for improving patient outcomes.
自发性冠状动脉夹层（SCAD）是急性冠状动脉综合征的一种罕见病因，主要影响无传统心血管危险因素的女性。由于其非典型表现以及与其他胸痛病因鉴别诊断的挑战，它常常被漏诊，尤其是在术后患者中。
我们报告一例62岁女性，患有2型糖尿病、高血压、高脂血症，近期因浸润性导管癌接受双侧乳房切除术，术后三天出现突发胸痛并向左臂放射。心电图显示ST段压低提示前壁缺血，心脏生物标志物显著升高。由于近期手术，影像学检查受限，但紧急冠状动脉造影确诊为自发性冠状动脉夹层。
该病例突出了手术应激作为无传统心血管危险因素患者发生SCAD的促发因素的潜在作用。大手术的生理应激可能导致动脉壁脆弱和夹层形成。术后环境中的诊断挑战需要高度怀疑以便及时识别。采取了保守治疗，这与当前指南一致，即在稳定的SCAD病例中倾向于非侵入性治疗以防止进一步夹层或并发症。
对于术后出现胸痛的患者，即使没有明显心血管危险因素，在急性冠状动脉综合征的鉴别诊断中也应考虑SCAD。早期识别和适当管理对于改善患者预后至关重要。
