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Conservative Management of Spontaneous Left Main Coronary Artery Dissection (SCAD) Triggered by Emotional Stress in the Late Postpartum Period: Case Report and Pathophysiology

A spontaneous coronary artery dissection (SCAD) during the postpartum period is a serious medical emergency and the most important non-atherosclerotic cause of coronary artery disease (CAD) in this population. While conservative management is recommended in most SCAD scenarios, cases complicated by...

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Autores principales: Zanchi, Jaksa, Miric, Dino, Giunio, Lovel, Bradaric Slujo, Anteo, Lozo, Mislav, Erceg, Duje, Orsulic, Duje, Borovac, Josip A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9680376/
https://www.ncbi.nlm.nih.gov/pubmed/36412632
http://dx.doi.org/10.3390/pathophysiology29040047
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author Zanchi, Jaksa
Miric, Dino
Giunio, Lovel
Bradaric Slujo, Anteo
Lozo, Mislav
Erceg, Duje
Orsulic, Duje
Borovac, Josip A.
author_facet Zanchi, Jaksa
Miric, Dino
Giunio, Lovel
Bradaric Slujo, Anteo
Lozo, Mislav
Erceg, Duje
Orsulic, Duje
Borovac, Josip A.
author_sort Zanchi, Jaksa
collection PubMed
description A spontaneous coronary artery dissection (SCAD) during the postpartum period is a serious medical emergency and the most important non-atherosclerotic cause of coronary artery disease (CAD) in this population. While conservative management is recommended in most SCAD scenarios, cases complicated by hemodynamic instability or cardiogenic shock are particularly challenging and might be amenable only with invasive percutaneous or cardiothoracic surgical management. Herein, we present a case of a 35-year-old otherwise healthy woman that suffered an intense emotional stress event and was subsequently admitted with crushing chest pain to the emergency department. The initial electrocardiogram showed dynamic changes suggesting anterolateral ST-elevation myocardial infarction. She gave birth to a healthy child 3 months before the current presentation. Diagnostic angiography found no occlusive CAD but instead an extensive intramural hematoma originating from the left main artery dissection and extending to the whole left coronary circulation was observed. Hemodynamic instability and hypotension soon followed, and the patient went into cardiogenic shock. The heart team opted for conservative and supportive intensive care management without surgical or percutaneous intervention. This decision ultimately led to the successful extubation of the patient and the achievement of hemodynamic stability. The patient was eventually safely discharged home without any permanent disability.
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spelling pubmed-96803762022-11-23 Conservative Management of Spontaneous Left Main Coronary Artery Dissection (SCAD) Triggered by Emotional Stress in the Late Postpartum Period: Case Report and Pathophysiology Zanchi, Jaksa Miric, Dino Giunio, Lovel Bradaric Slujo, Anteo Lozo, Mislav Erceg, Duje Orsulic, Duje Borovac, Josip A. Pathophysiology Case Report A spontaneous coronary artery dissection (SCAD) during the postpartum period is a serious medical emergency and the most important non-atherosclerotic cause of coronary artery disease (CAD) in this population. While conservative management is recommended in most SCAD scenarios, cases complicated by hemodynamic instability or cardiogenic shock are particularly challenging and might be amenable only with invasive percutaneous or cardiothoracic surgical management. Herein, we present a case of a 35-year-old otherwise healthy woman that suffered an intense emotional stress event and was subsequently admitted with crushing chest pain to the emergency department. The initial electrocardiogram showed dynamic changes suggesting anterolateral ST-elevation myocardial infarction. She gave birth to a healthy child 3 months before the current presentation. Diagnostic angiography found no occlusive CAD but instead an extensive intramural hematoma originating from the left main artery dissection and extending to the whole left coronary circulation was observed. Hemodynamic instability and hypotension soon followed, and the patient went into cardiogenic shock. The heart team opted for conservative and supportive intensive care management without surgical or percutaneous intervention. This decision ultimately led to the successful extubation of the patient and the achievement of hemodynamic stability. The patient was eventually safely discharged home without any permanent disability. MDPI 2022-10-26 /pmc/articles/PMC9680376/ /pubmed/36412632 http://dx.doi.org/10.3390/pathophysiology29040047 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Zanchi, Jaksa
Miric, Dino
Giunio, Lovel
Bradaric Slujo, Anteo
Lozo, Mislav
Erceg, Duje
Orsulic, Duje
Borovac, Josip A.
Conservative Management of Spontaneous Left Main Coronary Artery Dissection (SCAD) Triggered by Emotional Stress in the Late Postpartum Period: Case Report and Pathophysiology
title Conservative Management of Spontaneous Left Main Coronary Artery Dissection (SCAD) Triggered by Emotional Stress in the Late Postpartum Period: Case Report and Pathophysiology
title_full Conservative Management of Spontaneous Left Main Coronary Artery Dissection (SCAD) Triggered by Emotional Stress in the Late Postpartum Period: Case Report and Pathophysiology
title_fullStr Conservative Management of Spontaneous Left Main Coronary Artery Dissection (SCAD) Triggered by Emotional Stress in the Late Postpartum Period: Case Report and Pathophysiology
title_full_unstemmed Conservative Management of Spontaneous Left Main Coronary Artery Dissection (SCAD) Triggered by Emotional Stress in the Late Postpartum Period: Case Report and Pathophysiology
title_short Conservative Management of Spontaneous Left Main Coronary Artery Dissection (SCAD) Triggered by Emotional Stress in the Late Postpartum Period: Case Report and Pathophysiology
title_sort conservative management of spontaneous left main coronary artery dissection (scad) triggered by emotional stress in the late postpartum period: case report and pathophysiology
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9680376/
https://www.ncbi.nlm.nih.gov/pubmed/36412632
http://dx.doi.org/10.3390/pathophysiology29040047
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