Key result
Pregnancy-associated SCAD is the leading cause of pregnancy-associated MI and can present with postpartum hemorrhage.
Why the study?
Pregnancy-associated spontaneous coronary artery dissection (p-SCAD) is the leading cause of pregnancy-associated myocardial infarction, but its association with postpartum hemorrhage has not been described.
Case Report (n=1)
This case highlights that the etiologic assessment of pregnancy-associated SCAD should consider synergistic hormonal, hemodynamic, and inflammatory stressors, such as postpartum hemorrhage.
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Warrants high suspicion for SCAD in peripartum hemorrhage with instability; extends presentations of pregnancy-associated MI.
BACKGROUND: Pregnancy-associated spontaneous coronary artery dissection (p-SCAD) is the leading cause of pregnancy-associated myocardial infarction. CASE SUMMARY: A 32-year-old woman, G1P0, with gestational hypertension underwent cesarean delivery of twins, conceived with assisted reproductive technology. Because of uterine atony, she had postpartum hemorrhage requiring uterotonics and blood transfusion. She additionally tested positive for non-COVID coronavirus. On postoperative day 3, an electrocardiogram in the context of acute chest pain showed inferior and anterolateral ST-segment elevations. Coronary angiogram demonstrated type 2 SCAD of the left anterior descending artery and ostial second diagonal. Ejection fraction was mildly reduced (45%-50%) with apical hypokinesis. She was managed medically. Cross-sectional head to pelvis imaging was negative for fibromuscular dysplasia, aneurysm, and other dissections. DISCUSSION: To our knowledge, this is the first described case of p-SCAD after postpartum hemorrhage. TAKE-HOME MESSAGE: Etiologic assessment of SCAD should include hormonal, hemodynamic, and inflammatory stressors, whose roles remain incompletely understood but likely synergistic.
Kilkenny et al. (2026) conducted a case report in Pregnancy-associated spontaneous coronary artery dissection (n=1). Medical management was evaluated. A 32-year-old woman developed pregnancy-associated spontaneous coronary artery dissection following postpartum hemorrhage and was managed medically.
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