SCAD Gone Bad

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a common cause of acute coronary syndrome in younger women. It is often treated conservatively with spontaneous healing. Revascularization can be challenging and is reserved for those with complete occlusions, intractable angina, and hemodynamic compromise. CASE SUMMARY: A 31-year-old woman developed SCAD 8 days after vaginal delivery. Despite initial attempts at conservative management, she required escalative therapies ranging from percutaneous coronary intervention to mechanical circulatory support and ultimately heart transplantation in the setting of ischemic cardiomyopathy and cardiogenic shock. DISCUSSION: This case highlights the continuum of severity of SCAD, the risk of dissection propagation, and the need for multidisciplinary teams for SCAD treatment. TAKE-HOME MESSAGES: SCAD is a common cause of acute coronary syndrome in younger women. Although efforts should be made to defer intervention and opt for conservative management, multidisciplinary treatment teams must recognize progression that may ultimately require advanced therapies including cardiac transplantation.