Original reportSuccessful surgical treatment of spontaneous coronary artery dissection
Introduction
Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial infarction. It occurs in younger populations and has a predilection for women.1, 2, 3 Three major groups have been associated with SCAD: patients with atherosclerotic coronary artery disease, women in the postpartum period, and idiopathic causes.2 Coronary artery dissection is often fatal, with approximately 75% of cases diagnosed at autopsy.2, 4 The origin, pathogenesis, diagnosis, and treatment remain unclear. Both medical and surgical treatments exist; however, coronary artery bypass grafting has been commonly recommended.2 We present the case of SCAD in a postpartum woman with chest pain who underwent successful coronary artery bypass surgery.
Section snippets
Case report
A 37-year-old Caucasian woman presented to the emergency room with sudden onset of chest pain. She had no prior history of cardiovascular disease, trauma, or collagen tissue disease. Surgical history was pertinent for laparoscopic removal of an ovarian cyst and an abortion. At the time of presentation, the patient was 4 days postpartum from the delivery of her second child. She smoked 1 pack of cigarettes per day and drank alcohol minimally. She was taking no medications and was not on oral
Discussion
Spontaneous coronary artery dissection is a rare cause of myocardial infarction and is often fatal. Approximately 50% of patients with coronary artery dissection die abruptly and 18% to 20% die within hours.4 Spontaneous dissection of the coronary vasculature is less likely to occur than is secondary to blunt trauma, associated with aortic dissection, associated with collagen vascular disorders such as Marfan’s syndrome, sarcoidosis, angiitis, previous renal transplantation, or iatrogenic cases.
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