Pregnancy-Associated Spontaneous Coronary Artery Dissection in a 32-Year-Old Woman With Postpartum Hemorrhage

BACKGROUND: Pregnancy-associated spontaneous coronary artery dissection (p-SCAD) is the leading cause of pregnancy-associated myocardial infarction. CASE SUMMARY: A 32-year-old woman, G1P0, with gestational hypertension underwent cesarean delivery of twins, conceived with assisted reproductive technology. Because of uterine atony, she had postpartum hemorrhage requiring uterotonics and blood transfusion. She additionally tested positive for non-COVID coronavirus. On postoperative day 3, an electrocardiogram in the context of acute chest pain showed inferior and anterolateral ST-segment elevations. Coronary angiogram demonstrated type 2 SCAD of the left anterior descending artery and ostial second diagonal. Ejection fraction was mildly reduced (45%-50%) with apical hypokinesis. She was managed medically. Cross-sectional head to pelvis imaging was negative for fibromuscular dysplasia, aneurysm, and other dissections. DISCUSSION: To our knowledge, this is the first described case of p-SCAD after postpartum hemorrhage. TAKE-HOME MESSAGE: Etiologic assessment of SCAD should include hormonal, hemodynamic, and inflammatory stressors, whose roles remain incompletely understood but likely synergistic.