Case Report of Antepartum and Postpartum Spontaneous Coronary Artery Dissection in a High-Risk Pregnancy

Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome (ACS) that mainly affects women, particularly during or after pregnancy. A 38-year-old woman conceived via in vitro fertilization (IVF) presented at 34 weeks’ gestation with chest pain and rising troponin levels (191 ng/L → 5,500 ng/L; reference <52 ng/L). Initially patient was elected for medical management. Day later telemetry detected frequent non-sustained ventricular tachycardia (NSVT), considered a high-risk feature for underlying SCAD. Coronary angiography demonstrated a Type II SCAD of the mid-LAD (≈50% stenosis, TIMI III flow). She was managed conservatively with aspirin and labetalol. Hours later, she developed pre-eclampsia and underwent urgent caesarean section with complete symptom resolution. Two weeks postpartum, she re-presented with an inferior STEMI due to a Type II SCAD of the right PDA (TIMI II flow). Conservative management with temporary intra-aortic balloon pump support led to full recovery and preserved left-ventricular function.