Repeat Coronary Artery Dissection in Pregnancy: A Case Report and Review of the Literature.
Non-atherosclerotic spontaneous coronary artery dissection (NA-SCAD) is a rare cause of morbidity and mortality with a propensity for young, healthy, and often peripartum women. NA-SCAD etiology is poorly understood, with possible hormonal and hereditary mechanisms. Current treatment strategies range from conservative management (often showing resolution on angiographic follow-up) to invasive angiographic procedures. Rarely, NA-SCAD has recurred in another coronary artery, ranging hours to years later. We report NA-SCAD of the right coronary artery (RCA) in a 30-year old, 3-month postpartum female with an additional autopsy finding of remote myocardial infarction (MI) in the left anterior descending (LAD) coronary artery territory. The remote MI is consistent with prior NA-SCAD of the LAD and, given the medical history, may have occurred in the peripartum period of the decedent first pregnancy 3 years earlier. As such, to the best of our knowledge, this may represent the first reported case of NA-SCAD recurrence in a subsequent pregnancy.
Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM.|Office of the Medical Investigator, Albuquerque, NM.
Casey P
CP
Bitting
Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM.|Office of the Medical Investigator, Albuquerque, NM.
Ross E
RE
Zumwalt
D000328:Adult; D003328:Coronary Thrombosis / Q000473:pathology; D003330:Coronary Vessel Anomalies / Q000473:pathology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D009203:Myocardial Infarction / Q000473:pathology; D011247:Pregnancy; D011644:Puerperal Disorders / Q000473:pathology*; D014652:Vascular Diseases / Q000151:congenital* / Q000473:pathology
acute coronary syndrome; female; forensic pathology; forensic science; multiple; myocardial infarction; peripartum; pregnancy; recurrent; spontaneous coronary artery dissection