Document Type

Conference Proceeding

Publication Date

5-1-2026

Abstract

Spontaneous coronary artery dissection (SCAD) is a tear in the coronary artery lining which decreases blood flow to the heart. SCAD is the leading cause of myocardial infarction in young to middle aged women, especially during and after pregnancy. While SCAD is often managed conservatively, patients are prone to complications like cardiomyopathy. This case underscores the importance of considering SCAD as a differential for postpartum women with chest pain. Furthermore, this case highlights the diagnosis and management of an atypical stress-induced cardiomyopathy with global hypokinesis following postpartum SCAD. A 37-year-old female postpartum for five weeks presented to our hospital with sharp, left chest pain and shortness of breath. On admission, her troponin was mildly elevated and EKG showed anterior lateral T-wave changes. Her 2D echo showed an ejection fraction of 55% with no wall motion abnormalities. A coronary computed tomography angiography (CCTA) revealed a single vessel non-calcified plaque in the proximal left anterior descending artery (LAD) concerning for >70% stenosis. She then underwent a coronary angiography which showed an extensive spiral dissection of the entire LAD with complete perfusion (TIMI III flow). Her findings were consistent with a diagnosis of SCAD. She was monitored in the cardiac care unit and treated conservatively with dual anti-platelet therapy, beta blocker, and IV nitroglycerin before discharge. Two weeks later, the patient again presented with an episode of chest pain and shortness of breath similar to her SCAD admission. During this admission, she had an elevated troponin and D-dimer. Her EKG revealed no changes. Her 2D echo showed a decrease in her ejection fraction to 40% with global hypokinesis. However, a CCTA was performed and displayed improvement in the proximal LAD dissection with stable distal LAD dissection. Her symptoms were suspected to be caused by a stress-induced cardiomyopathy related to postpartum. She was started on guideline-directed management therapy, including an angiotensin receptor-neprilysin inhibitor and beta-blocker, and provided with resources for SCAD support groups. At her three month follow up, her 2D echo showed an improvement in her ejection fraction to 60% with no segmental wall motion abnormalities.

Comments

American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2026 Resident and Medical Student Day, May 1, 2026, Troy, MI

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