title: Pregnancy-Related Spontaneous Coronary Artery Dissection: A Case Series and Literature Review.
abstract: BACKGROUND
  Cardiac emergencies during pregnancy are rare but have significant associated morbidity and mortality when they do occur. The emergency physician must not only be aware of potentially life-threatening conditions in the pregnant woman, but also know the emergent management and treatment of these conditions to avoid worsening of the underlying condition. Pregnancy-related spontaneous coronary artery dissection has been described in the cardiology literature, but is not well-known in emergency medicine literature.
  
  
  METHODS
  We present a case series of six previously healthy women ages 27 to 39 years who presented 1 to 75 days after delivery with spontaneous coronary artery dissection. The left main coronary was involved in 5 of 6 cases. One patient died, 5 survived. Two survivors maintained significant long-term disability. The patient that died had the diagnosis made on autopsy, the others were diagnosed with coronary angiography. Two patients were treated with stents, 2 with coronary artery bypass surgery, and 2 with medical management. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergent coronary catheterization is indicated if this diagnosis is suspected. However, emergency care teams must also understand how and why management including coronary artery catheterization can exacerbate the underlying condition. The role of coronary artery computed tomography remains unknown, although it exposes the fetus to significant radiation if the woman is still pregnant at presentation. Medical management is indicated with diffuse or distal disease as pregnancy-related coronary artery dissections often resolve with time. Localized discrete lesions may be stented. Coronary artery bypass graft surgery may be considered if the left main artery is involved or there are multiple proximal lesions. Cardiac transplantation is indicated rarely.
authors.affiliation: Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, LAC+USC Medical Center, Los Angeles, California.
authors.forename: Emily
authors.initials: E
authors.lastname: Rose
authors.affiliation: Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
authors.forename: Maheedhar
authors.initials: M
authors.lastname: Gedela
authors.affiliation: Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
authors.forename: Nathan
authors.initials: N
authors.lastname: Miller
authors.affiliation: Department of Cardiology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Carpenter
mesh_terms: D000328:Adult; D002637:Chest Pain / Q000209:etiology; D003330:Coronary Vessel Anomalies / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D004562:Electrocardiography / Q000379:methods; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D007022:Hypotension / Q000209:etiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality; D011859:Radiography / Q000379:methods; D014336:Troponin / Q000032:analysis / Q000097:blood; D014652:Vascular Diseases / Q000150:complications / Q000151:congenital* / Q000175:diagnosis / Q000401:mortality
chemical_list: D014336:Troponin
keywords: coronary artery catheterization in pregnancy; myocardial infarction in pregnancy; pregnancy-related cardiac emergencies; pregnancy-related coronary artery dissection