title: A rare cause of postpartum chest pain.
abstract: We report the case of a 45-year-old postpartum female at low risk for coronary artery disease (CAD) who presented with chest pain, a normal electrocardiogram (ECG) and elevation of serial troponin-T levels. Coronary angiography revealed dissection of the first obtuse marginal branch of the left circumflex coronary artery. The patient was treated medically and discharged home safely. Spontaneous coronary artery dissection (SCAD) is a rare condition. In the absence of CAD, it is seen most frequently in young females during the peripartum period. Insult from the hemodynamic stresses during pregnancy and labor combined with the underlying pregnancy related arterial wall changes is the proposed mechanism of dissection in this setting. The normal ECG in the presence of an acute myocardial infarction (AMI) in this case also demonstrates the occasional electrically silent ECG that can occur during acute compromise of the left circumflex coronary artery.
authors.affiliation: WVU Department of Medicine, Section of Cardiovascular Diseases, Morgantown, USA.
authors.forename: Sumesh
authors.initials: S
authors.lastname: Jain
authors.forename: Bruce
authors.initials: B
authors.lastname: Chen
authors.forename: Jason A
authors.initials: JA
authors.lastname: Moreland
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002637:Chest Pain / Q000188:drug therapy / Q000209:etiology*; D017023:Coronary Angiography / Q000379:methods; D003330:Coronary Vessel Anomalies / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009566:Nitrates / Q000627:therapeutic use; D049590:Postpartum Period; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000150:complications / Q000151:congenital* / Q000000981:diagnostic imaging / Q000188:drug therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009566:Nitrates; D001241:Aspirin