title: Spontaneous coronary artery dissection in a parturient with Nail-Patella syndrome.
abstract: Spontaneous coronary artery dissection is an uncommon cause of acute coronary syndrome, occurring predominantly in women during and immediately after pregnancy; it carries a mortality rate of greater than 50%. While the exact etiology is unknown, possible contributing factors include pregnancy-related hormonal, connective tissue and hemodynamic changes. We present a case of a 35-year-old multigravid woman with Nail-Patella syndrome who developed an acute myocardial infarction secondary to spontaneous coronary artery dissection during labor which was not diagnosed until after delivery. We hypothesize that abnormal collagen fiber formation found in Nail-Patella syndrome may have put her at an increased risk of coronary dissection and myocardial infarction. Regardless of etiology, a delay in diagnosis of myocardial ischemia can lead to significant morbidity and mortality. In light of the increasing burden of cardiac disease in the obstetric population, clinicians should remain vigilant for signs of myocardial infarction and prepare for definitive diagnosis and treatment.
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA. Electronic address: snizamuddin@partners.org.
authors.forename: S L
authors.initials: SL
authors.lastname: Nizamuddin
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: D K
authors.initials: DK
authors.lastname: Broderick
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Minehart
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: B B
authors.initials: BB
authors.lastname: Kamdar
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D050034:Antidiuretic Agents / Q000627:therapeutic use; D001241:Aspirin; D003330:Coronary Vessel Anomalies / Q000150:complications* / Q000628:therapy; D054855:Drug-Eluting Stents; D005260:Female; D005665:Furosemide; D006493:Heparin; D006801:Humans; D008790:Metoprolol; D009203:Myocardial Infarction / Q000209:etiology* / Q000628:therapy; D009261:Nail-Patella Syndrome / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D014652:Vascular Diseases / Q000150:complications / Q000151:congenital* / Q000628:therapy
chemical_list: D000889:Anti-Arrhythmia Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D050034:Antidiuretic Agents; D005665:Furosemide; D006493:Heparin; D008790:Metoprolol; D001241:Aspirin
keywords: Acute coronary syndrome; Coronary artery dissection; Nail–Patella syndrome