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Acute myocardial infarction caused by spontaneous postpartum coronary artery dissection

Abstract

Background A 34-year-old postpartum woman presented at hospital with chest pain. She had experienced an uneventful delivery of a healthy infant and had no known coronary risk factors. Electrocardiography demonstrated an acute myocardial infarction, which resolved on intravenous glyceryl trinitrate infusion. Coronary angiography revealed diffuse narrowing of the left anterior descending artery and tapering of the left main trunk, but there were no obvious hallmarks of intimal dissection.

Investigations Electrocardiography, coronary angiography, multidetector CT and intravascular ultrasonography.

Diagnosis Postpartum coronary artery dissection.

Management The lesion was stabilized with orally administered amlodipine, aspirin, ticlopidine and pitavastatin, along with intravenous heparin and glyceryl trinitrate. The patient was later discharged on bisoprolol, aspirin, pitavastatin and temocapril.

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Figure 1: Angiogram of the patient showing a diffuse coronary lesion of the left anterior descending artery and 40% tapering of the left main trunk.
Figure 2: Multidetector CT demonstrated that the coronary lesion had not resolved after 10 days of pharmacological therapy.
Figure 3: Coronary angiography performed 3 months after the initial myocardial infarction showed complete resolution of the lesion.
Figure 4: Intravascular ultrasonography, performed 3 months after presentation, confirmed the presence of a spiral dissection.

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Correspondence to Masahiko Satoda.

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The authors declare no competing financial interests.

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Satoda, M., Takagi, K., Uesugi, M. et al. Acute myocardial infarction caused by spontaneous postpartum coronary artery dissection. Nat Rev Cardiol 4, 688–692 (2007). https://doi.org/10.1038/ncpcardio1055

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  • DOI: https://doi.org/10.1038/ncpcardio1055

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