Spontaneous coronary artery dissection after an elective C-s
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A 36-year-old healthy gravida 3, para 3 woman with a history of asthma and elective cesarean delivery 11 days prior presented to the emergency department with 3 days of exertional chest pain. The pain was described as crushing and substernal, but she denied radiation or associated dyspnea, nausea, vomiting, or diaphoresis.

On physical examination, her blood pressure was 167/105 mm Hg bilaterally, heart rate was 71/min, respiratory rate 18/min, and oxygen saturation 98% on room air. Initial laboratory evaluation revealed a troponin I level of 0.12 ng/mL (reference range, 0.00-0.04 ng/mL).

ECG revealed normal sinus rhythm with diffuse ST-segment depressions but without q waves or ST-segment elevation. CT ngiography did not show pulmonary embolism or aortic dissection. Echocardiography demonstrated a left ventricular ejection fraction of 53%, with apical akinesis and no valvular disease.

The patient was started on aspirin and ticagrelor, heparin infusion, and metoprolol tartrate for treatment of non–ST-segment elevation myocardial infarction. She underwent coronary angiography.

She was diagnosed with spontaneous coronary artery dissection (SCAD). The patient was prescribed metoprolol succinate, aspirin, and clopidogrel. Her chest pain resolved, and her troponin I level peaked at 1.25 ng/mL. At 4-month follow-up, an echocardiogram showed resolution of the apical wall motion abnormality. She remained active and asymptomatic at 9-month follow-up.

Read more here: https://jamanetwork.com/journals/jama/fullarticle/2716410