Spontaneous Coronary Artery Dissection with Sudden Cardiac Arrest in a Female Patient During Her Postpartum Period: A Case Report and Review
Unknown etiology, Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Unexpected drug reaction , Educational Purpose (only if useful for a systematic review or synthesis)
Moath A. Binhomaid, Faisal Alhusain, Mohammad Al Deeb
Department of Emergency Medicine, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
Am J Case Rep 2021; 22:e930380
Available online: 2021-08-06
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction, and the literature is undecided on the etiology, predisposing factors, and susceptible populations involved. SCAD is a disease that is under-recognized, underdiagnosed, and mainly affects young women of reproductive age. It has the highest incidence in the third trimester and postpartum period.
CASE REPORT: We present a case of a 29-year-old woman who was brought by family members to our Emergency Department (ED) in Riyadh, Saudi Arabia with sudden cardiac arrest due to SCAD in the right coronary artery 13 days after normal spontaneous vaginal delivery. The patient was brought in with no cardiopulmonary resuscitation for 20 min. She was resuscitated successfully in the ED. Her initial rhythm was ventricular fibrillation (VF). Point-of-care ultrasound (PoCUS) was performed during pulse checks, which revealed no signs of right ventricular strain nor signs of deep vein thrombosis (DVT). After that, she underwent primary percutaneous coronary intervention, which confirmed the diagnosis of right coronary artery dissection. The patient was successfully managed and discharged from the hospital after 18 days. She was independent and in good health after 4 months of follow-up.
CONCLUSIONS: A high index of suspicion, familiarity with predisposing factors for SCAD, and PoCUS may play a critical role in detecting and managing SCAD patients.
Keywords: Chest Pain, Dissection, Heart Arrest, Postpartum Period