Repeat Coronary Artery Dissection in Pregnancy: A Case Report and Review of the Literature1. Issue 5 (7th February 2017)

• Record Type: Journal Article
• Authors: Bitting, Casey P.; Zumwalt, Ross E.
• Is Part Of: Journal of forensic sciences. Volume 62:Issue 5(2017)
• Page Start: 1389
• Page End: 1394
• Publication Date: 2017-02-07
• Subjects: forensic science -- forensic pathology -- pregnancy -- peripartum -- myocardial infarction -- female -- spontaneous coronary artery dissection -- multiple -- acute coronary syndrome -- recurrent; Medical jurisprudence -- Periodicals; Forensic sciences -- Periodicals; Forensic Medicine -- Periodicals; Gerechtelijke geneeskunde; Gerechtelijke chemie; Gerechtelijke psychiatrie; 363.2505
• DOI: 10.1111/1556-4029.13436
• Languages: English
• ISSNs: 0022-1198

Abstract

Abstract: 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.