Pregnancy-associated spontaneous coronary artery dissection (PASCAD): An etiology for chest pain in the young peripartum patient

CJEM
Richard Lee, David Carr

Abstract

Cardiac emergencies in pregnancy and the postpartum period are rare but often life-threatening. An emergency physician's differential diagnosis for chest pain in the peripartum patient often includes serious etiologies such as pulmonary embolism or myocardial infarction (MI). A lesser-known but important consideration on the differential for MI is that of a spontaneous coronary artery dissection (SCAD). SCAD is defined as an intramural hematoma within the coronary artery that compresses the true lumen. Expansion by increased pressures may lead to subsequent myocardial ischemia and infarction. This condition is the most common cause of pregnancy-associated MI and is reported as the cause of MI in 24% to 35% of all women younger than 50 years. This condition is predominately seen in young healthy females with no traditional risk factors for coronary artery or cardiac disease, and typically in the postpartum period. SCAD in the peripartum period is defined as pregnancy-associated spontaneous coronary artery dissection (PASCAD). Abnormal ECG changes, elevated troponins, and regional wall motional abnormalities on echocardiography are all diagnostic findings of SCAD, which can be ultimately confirmed with coronary angiography. Failu...Continue Reading

References

Apr 28, 2007·The Annals of Thoracic Surgery·Siamak AliyaryClemens von Birgelen
Dec 7, 2007·American Journal of Obstetrics and Gynecology·Sorel GolandLawrence S C Czer
Jun 29, 2010·The American Journal of Emergency Medicine·Leo MarcoffEhsanur Rahman
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Mar 19, 2013·The Canadian Journal of Cardiology·Jacqueline Saw
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Aug 8, 2015·Mayo Clinic Proceedings·Marysia S TweetSharonne N Hayes
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Mar 18, 2017·Circulation. Cardiovascular Interventions·Ofer HavakukUri Elkayam
Apr 12, 2017·The Journal of Emergency Medicine·Emily RosePaul L Carpenter

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Citations

Aug 20, 2021·Current Cardiology Reports·Anas AlamehAnkur Kalra

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