Acute Myocardial Infarction Due to Spontaneous Coronary Dissection in Pregnancy: A Case Report and Management Considerations

Acute myocardial infarction (AMI) during pregnancy is a rare but life-threatening condition with unique pathophysiological mechanisms and management challenges. We present the case of a 28-year-old woman at 37 weeks of gestation who developed AMI due to spontaneous coronary artery dissection (SCAD). Initially admitted with retrosternal pain and transient electrocardiographic changes, she exhibited a significant rise in troponin levels, prompting a multidisciplinary reassessment. Conservative management was initially pursued, but recurrent chest pain and worsening electrocardiographic findings necessitated urgent coronary angiography. The procedure confirmed a long dissection of the left circumflex artery, successfully treated with percutaneous coronary intervention using a "stent-in-stent" technique. Given the high-risk nature of her pregnancy, anticoagulation therapy was carefully adjusted to minimize peripartum hemorrhagic complications. At 39 weeks, she underwent cesarean delivery of a healthy neonate. Follow-up evaluation one year post-intervention showed overall improvement, with only minor residual sequelae, including mildly reduced left ventricular function and subtle electrocardiographic changes. This case underscores the complexities of diagnosing and managing SCAD-related AMI in pregnancy, emphasizing the need for individualized treatment strategies that balance maternal cardiovascular risks with fetal safety. Given the rarity of SCAD in this population and the limitations of standardized guidelines, accumulating clinical experience is essential to refine management approaches in future cases.