title: Postpartum multivessel coronary dissection.
abstract: A 29-year-old woman had an acute myocardial infarction 5 days after giving birth. Serial coronary angiography showed multiple progressive coronary artery dissections, which eventually involved both the right and left coronary trees. Persistent cardiogenic shock necessitated emergent orthotopic heart transplantation. Examination of the cardiectomy specimen confirmed the presence of multiple myocardial infarctions, coronary artery dissection, and fibromuscular dysplasia of the coronary arteries. Fibromuscular dysplasia combined with changes in the arterial ground substance and hormonal milieu attributable to pregnancy or parturition are proposed as possible causes of coronary artery dissection in this case.
authors.affiliation: Temple University Hospital, Division of Cardiology, Philadelphia, Pa 19140.
authors.forename: P J
authors.initials: PJ
authors.lastname: Mather
authors.forename: C L
authors.initials: CL
authors.lastname: Hansen
authors.forename: B
authors.initials: B
authors.lastname: Goldman
authors.forename: S
authors.initials: S
authors.lastname: Inniss
authors.forename: I
authors.initials: I
authors.lastname: Piña
authors.forename: R
authors.initials: R
authors.lastname: Norris
authors.forename: V
authors.initials: V
authors.lastname: Jeevanandam
authors.forename: A A
authors.initials: AA
authors.lastname: Bove
mesh_terms: D000328:Adult; D003327:Coronary Disease / Q000150:complications* / Q000473:pathology; D005260:Female; D005352:Fibromuscular Dysplasia / Q000150:complications* / Q000473:pathology; D016027:Heart Transplantation; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology* / Q000473:pathology; D049590:Postpartum Period; D012422:Rupture, Spontaneous; D012770:Shock, Cardiogenic / Q000209:etiology