Spontaneous left main coronary artery dissection complicated with vasospasm. How would I approach it?

Abstract

HOW WOULD I APPROACH IT? Several cases have been published in the medical literature on peripartum spontaneous coronary artery dissection. Its pathophysiology largely remains unknown, although in a significant percentage of cases fibromuscular dysplasia seems to play some sort of role.1 We present the case of a 36-year-old woman with spontaneous coronary artery dissection of left main coronary artery (LMCA) and left anterior descending coronary artery (LAD) 2 months after delivery. The patient shows clinical signs of thoracic pain and dyspnea with 1-hour of evolution, T-wave inversion on the electrocardiogram, and elevated cardiac enzyme levels. She remains hemodynamically stable without compromise to the left ventricular function. The coronary angiography performed revealed a suspicious image of diffuse reduction of the blood lumen area on the LMCA and LAD. At an early moment, conservative treatment was administered. In my opinion, the early treatment was appropriate since, according to the largest series published to this date—Canadian2—the in-hospital prognosis is often good and only 3.3% of the patients on conservative treatment required revascularization. This has been confirmed in a study that assessed the infarction size on a cardiac magnetic resonance imaging in patients with spontaneous coronary artery dissection.3 Our experience is consistent with this study and in...