Computed Tomography Coronary Angiogram as a First-Line Diagnostic Tool in Pregnancy-Associated Spontaneous Coronary Artery Dissection: A Case Report of Left Main Stem and Left Anterior Descending Artery Dissection at 35 Weeks' Gestation

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial infarction, typically affecting younger individuals without traditional risk factors for atherosclerotic cardiovascular disease. The underlying pathophysiology differs entirely from that of atherosclerotic myocardial infarction, necessitating distinct diagnostic and management strategies. When SCAD occurs during pregnancy, it is termed pregnancy-associated SCAD (P-SCAD). Because of its rarity, no standardized guidelines currently exist for the diagnosis and management of P-SCAD. We report the case of a 37-year-old woman at 35 weeks' gestation, with no traditional atherosclerotic risk factors, who presented with chest pain. Her electrocardiogram (ECG) showed subtle changes suggestive of anterior ST-elevation myocardial infarction. Considering the procedural risks associated with an invasive coronary angiogram, a computed tomography (CT) coronary angiogram was performed first, confirming dissection involving the left main stem and proximal left anterior descending (LAD) artery. She experienced a brief episode of pulmonary edema that responded well to furosemide and subsequently remained hemodynamically stable. The patient was monitored in the hospital and later delivered uneventfully about four weeks after the event. This case highlights the value of CT coronary angiogram as a non-invasive diagnostic option in hemodynamically stable antepartum patients with suspected SCAD, providing a safe alternative to invasive angiography in selected cases.