Defining the Cause of Postpartum Myocardial Infarction – Another Use for Optical Coherence Tomography

  • Abdullah Alenezi Adult Cardiology Department, Chest Diseases Hospital, Kuwait
  • Jadan Alsaddah Adult Cardiology Department, Chest Diseases Hospital, Kuwait
  • Ossama Maadarani Internal Medicine Department, Ahmadi Hospital - Kuwait Oil Company, Kuwait

Keywords

spontaneous coronary artery dissection, optical coherence tomography, postpartum

Abstract

Chest pain in a young postpartum female can have many causes; however, when associated with ST elevation on ECG, spontaneous coronary artery dissection (SCAD) should be high on the list. Coronary angiography remains the first step in delineating the coronary lesion in suspected cases of SCAD and optical coherence tomography (OCT) can be crucial when the angiographic appearance remains uncertain. We present a case of a young postpartum female with ST elevation myocardial infarction (STEMI). Coronary angiography revealed a dilated part of the middle segment of the left anterior descending (LAD) artery while intramural haematoma (IMH) of the coronary artery wall was found on OCT, which confirmed the clinically suspected diagnosis of SCAD.

VIEW THE ENTIRE ARTICLE

References

Elkayam U, Jalnapurkar S, Barakkat MN, Khatri N, Kealey AJ, Mehra A, et al. Pregnancy-associated acute myocardial infarction: a review of contemporary experience in 150 cases between 2006 and 2011. Circulation 2014;129:1695–1702.

Hayes SN, Kim ESH, Saw J, Adlam D, Arslanian-Engoren C, Economy KE, et al. Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association. Circulation 2018;137(19):e523–e557.

Vanzetto G, Berger-Coz E, Barone-Rochette G, Chavanon O, Bouvaist H, Hacini R, et al. Prevalence, therapeutic management and medium-term prognosis of spontaneous coronary artery dissection: results from a database of 11,605 patients. Eur J Cardiothorac Surg 2009;35:250–254.

Ciraulo DA, Chesne RB. Coronary arterial dissection: an unrecognized cause of myocardial infarction, with subsequent coronary arterial patency. Chest 1978;73:677–679.

Guagliumi G, Capodanno D, Saia F, Musumeci G, Tarantini G, Garbo R, et al. Mechanisms of atherothrombosis and vascular response to primary percutaneous coronary intervention in women versus men with acute myocardial infarction: results of the OCTAVIA study. JACC Cardiovasc Interv 2014;7:958–968.

Alfonso F, Canales E, Aleong G. Spontaneous coronary artery dissection: diagnosis by optical coherence tomography. Eur Heart J 2009;30:385.

Vijayaraghavan R, Verma S, Gupta N, Saw J. Pregnancy-related spontaneous coronary artery dissection. Circulation 2014;130:1915–1920.

Nakashima T, Noguchi T, Haruta S, Yamamoto Y, Oshima S, Nakao K, et al. Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: a report from the Angina Pectoris-Myocardial Infarction Multicenter Investigators in Japan. Int J Cardiol 2016;207:341–348.

Saw J. Coronary angiogram classification of spontaneous coronary artery dissection. Catheter Cardiovasc Interv 2014;84:1115–1122.

Alfonso F, Paulo M, Dutary J. Endovascular imaging of angiographically invisible spontaneous coronary artery dissection. JACC Cardiovasc Interv 2012;5:452–453.

Tweet MS, Eleid MF, Best PJ, Lennon RJ, Lerman A, Rihal CS, et al. Spontaneous coronary artery dissection: revascularization versus conservative therapy. Circ Cardiovasc Interv 2014;7:777–786.

Published: 2020-08-17

Issue: Vol 7 No 11 (view)

Section: Articles

How to cite:
1.
Alenezi A, Alsaddah J, Maadarani O. Defining the Cause of Postpartum Myocardial Infarction – Another Use for Optical Coherence Tomography. EJCRIM 2020;7 doi:10.12890/2020_001854.