Management After Spontaneous Coronary Artery Dissection in Pregnancy

We present the case of a patient diagnosed with myocardial infarction secondary to presumed pregnancy-associated spontaneous coronary artery dissection (P-SCAD) at 29 weeks of gestation and describe our multi-disciplinary approach to her care. We conclude with a review of existing literature and our recommendations for the care of antenatally diagnosed P-SCAD.

We present a case of a SCAD in a patient at 29 weeks and 2 days gestation who exhibited symptoms and work-up consistent with SCAD. Interventional diagnostic cardiac testing was deferred. She initially required admission to an intensive care unit for cardiac and pulmonary support and ultimately remained hospitalized until delivery due to limited access to tertiary care in her remote home location. Her antenatal course was uneventful; she underwent an uncomplicated scheduled repeat cesarean section and a bilateral salpingectomy at 36 weeks and 4 days.

Patients with P-SCAD should be delivered at a level 4 maternal care center, and their care plan should be comprehensively discussed by a multi-disciplinary pregnancy heart team comprising experts from maternal-fetal medicine, cardiology, obstetrics anesthesiology critical care, and neonatology. These patients should also have a detailed contingency plan in place, addressing both cardiac emergencies and unscheduled obstetric events in the antenatal setting to ensure prompt and effective responses. This case underscores the critical significance of implementing tailored antenatal management strategies to ensure optimal outcomes for pregnant individuals with SCAD.