Postpartum SCAD After Prior SCAD Despite Comprehensive Multidisciplinary Management

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is the leading cause of pregnancy-associated myocardial infarction and is associated with severe presentations and increased recurrence risk, particularly postpartum. CASE SUMMARY: A 38-year-old woman with previous conservatively managed left anterior descending artery SCAD presented 9 days postpartum with infero-posterior ST-segment elevation myocardial infarction. Coronary angiography demonstrated extensive multisegment right coronary artery SCAD. She remained hemodynamically stable and was managed conservatively with favorable short-term outcomes despite recurrent SCAD. DISCUSSION: This case highlights pregnancy as a potent trigger for recurrent SCAD and the vulnerability of the early postpartum period. Recurrence occurred despite multidisciplinary management, specialist follow-up, and planned cesarean delivery, underscoring limitations of current risk-mitigation strategies. Despite expert consensus guidance of pregnancy avoidance, both unplanned and planned pregnancies may occur after SCAD; comprehensive counseling regarding recurrence risk remains essential. TAKE-HOME MESSAGE: Early postpartum SCAD recurrence may occur despite optimal care and can be unpredictable and life-threatening.