Key result
Conservative management with heart rate control using beta-blockers and aspirin was successfully utilized to manage pregnancy-associated spontaneous coronary artery dissection.
Why the study?
Pregnancy-associated spontaneous coronary artery dissection carries high maternal morbidity and mortality, but hesitation regarding coronary interventions persists and management guidelines remain based solely on expert consensus.
Case Report (n=1)
This case highlights the feasibility of conservative management with heart rate control for pregnancy-associated spontaneous coronary artery dissection and emphasizes the importance of multidisciplinary cardio-obstetrics care.
Supports individualized P-SCAD intervention in pregnancy; leaves optimal strategies open pending higher-level evidence.
Due to the potential for severe maternal morbidity and even mortality, pregnancy-associated spontaneous coronary artery dissection (P-SCAD) often presents as a clinical conundrum. While current recommendations encourage coronary interventions when medically indicated even during pregnancy, the hesitation still understandably exists. Meanwhile, given the rarity of the condition, the guidelines for management are still based on expert consensus. We present a case of P-SCAD in a 38-year-old woman with initial presentation at 28 weeks' gestation and recurrence at 9 days postpartum. A unique complication of this case is its transcontinental nature: the initial event occurred while the patient was on vacation across the country from her home. Questions arose not only with regard to her immediate management and care but also when she would be able to travel and how her complex care would be continued cross-country. This case raised important questions regarding the antepartum management of acute coronary syndrome (ACS). It also highlights the importance of multidisciplinary care, especially with a cardio-obstetrics team, in the management of P-SCAD and emphasizes the role for universal screening for cardiac diseases in pregnancy.
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Pham et al. (2024) conducted a case report in Pregnancy-associated spontaneous coronary artery dissection (P-SCAD) (n=1). Conservative management (heart rate control with metoprolol and aspirin) was evaluated. Conservative management with heart rate control using beta-blockers and aspirin was successfully utilized to manage pregnancy-associated spontaneous coronary artery dissection.
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