Postpartum spontaneous coronary artery dissection – a case report

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized non-atherosclerotic cause of acute coronary syndrome (ACS), particularly affecting young women in the peripartum or postpartum period. We report the case of a 39-year-old woman, 3 months postpartum and breastfeeding, who presented with acute central chest pain radiating to the left arm and associated dyspnea. She had no cardiovascular risk factors. Her electrocardiogram showed dynamic T-wave inversions in the anterolateral leads, and high-sensitivity troponin-T was elevated at 454 ng/L. Transthoracic echocardiography demonstrated a left ventricular ejection fraction of 45% with apical hypokinesis. Coronary angiography demonstrated a 99% stenosis in the mid-left anterior descending artery, consistent with type 2 SCAD. The patient was hemodynamically stable and managed conservatively with beta-blocker, ACE inhibitor, and dual antiplatelet therapy. Breastfeeding was discontinued following shared decision-making due to concerns over medication safety. Screening for fibromuscular dysplasia with CT angiography of the carotid and renal arteries was unremarkable. At 6 months, CT coronary angiography showed complete resolution of the dissection and normal coronary anatomy, allowing cessation of antiplatelet therapy in line with the patient’s preference to resume breastfeeding. Interval echocardiography also demonstrated recovery of left ventricular ejection fraction to 62%. This case highlights the importance of considering SCAD in young postpartum women presenting with ACS. Prompt diagnosis and tailored conservative management can result in excellent outcomes. Longitudinal imaging, medication review, and reproductive counselling are essential in the follow-up of such patients with the need for patient-centered care in the context of breastfeeding and future pregnancies.