Key result
Conservative intensive care management successfully stabilizes left main SCAD complicated by cardiogenic shock.
Why the study?
SCAD complicated by hemodynamic instability or cardiogenic shock is challenging and often thought to require invasive revascularization, leaving optimal management approaches uncertain.
Case Report (n=1)
This case demonstrates that careful conservative management combined with intensive supportive care can be a successful strategy even for high-risk SCAD cases involving the left main stem and complicated by cardiogenic shock.
May support conservative stabilization in select left main SCAD with shock; leaves open generalizability without controlled trials.
A spontaneous coronary artery dissection (SCAD) during the postpartum period is a serious medical emergency and the most important non-atherosclerotic cause of coronary artery disease (CAD) in this population. While conservative management is recommended in most SCAD scenarios, cases complicated by hemodynamic instability or cardiogenic shock are particularly challenging and might be amenable only with invasive percutaneous or cardiothoracic surgical management. Herein, we present a case of a 35-year-old otherwise healthy woman that suffered an intense emotional stress event and was subsequently admitted with crushing chest pain to the emergency department. The initial electrocardiogram showed dynamic changes suggesting anterolateral ST-elevation myocardial infarction. She gave birth to a healthy child 3 months before the current presentation. Diagnostic angiography found no occlusive CAD but instead an extensive intramural hematoma originating from the left main artery dissection and extending to the whole left coronary circulation was observed. Hemodynamic instability and hypotension soon followed, and the patient went into cardiogenic shock. The heart team opted for conservative and supportive intensive care management without surgical or percutaneous intervention. This decision ultimately led to the successful extubation of the patient and the achievement of hemodynamic stability. The patient was eventually safely discharged home without any permanent disability.
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Zanchi et al. (2022) conducted a case report in Spontaneous coronary artery dissection (SCAD) (n=1). Conservative management was evaluated on Clinical recovery and hemodynamic stability. Conservative and supportive intensive care management successfully stabilized a patient with spontaneous left main coronary artery dissection complicated by cardiogenic shock, leading to safe discharge.
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