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Pregnancy-associated spontaneous coronary artery dissection: multidisciplinary management, challenges and literature review
  1. Nnadozie Igbokwe1,
  2. Jess Gomersall1,
  3. Sunday Paul Ugwoke1 and
  4. Sean Esmonde2
  1. 1Obstetrics and Gynaecology, Royal Jubilee Maternity Service, Belfast, UK
  2. 2Cardiology, Royal Victoria Hospital, Belfast, UK
  1. Correspondence to Dr Nnadozie Igbokwe; dozzybarry4{at}gmail.com

Abstract

A 30-year-old woman in her second pregnancy, which was complicated by gestational diabetes mellitus. She had an uneventful spontaneous vaginal delivery at 38 weeks+3 days of gestation. Day 1 postpartum, she developed sudden chest pain radiating to her jaw and neck. Her observations were normal, and ECG showed lateral ST elevation in keeping with acute myocardial infarction. The troponin-T level was elevated at 21 ng/L at 0 hour, and >10 000 ng/L at 12 hours, respectively. Coronary angiography confirmed spontaneous dissection of the proximal left anterior descending (LAD) and proximal circumflex coronary arteries. She became unstable during percutaneous coronary intervention and consequently had a successful coronary artery bypass surgery with left saphenous vein grafts to the first obtuse marginal artery and LAD. Echocardiogram revealed moderate to severe impairment of the left ventricular function postoperatively.

  • interventional cardiology
  • pregnancy

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Footnotes

  • Contributors NI obtained the patient consent, did an extensive literature review, and wrote the case report and references in accordance with BMJ Case Reports policy. JG managed the patient, suggested the case report and did the final editing and correction. SPU summarised the case note and did the initial correction. SE was involved in the cardiology management of the patient in CathLab and provided an extensive cardiology review of the manuscript, including response to the reviewer comment and the images/videos supplied.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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