TY - JOUR T1 - Pregnancy-associated spontaneous coronary artery dissection: multidisciplinary management, challenges and literature review JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2021-244851 VL - 14 IS - 12 SP - e244851 AU - Nnadozie Igbokwe AU - Jess Gomersall AU - Sunday Paul Ugwoke AU - Sean Esmonde Y1 - 2021/12/01 UR - http://casereports.bmj.com/content/14/12/e244851.abstract N2 - 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. ER -