Abstract

Spontaneous coronary artery dissection (SCAD) which was first described by Pretty in 1931 is rare but significant cause of myocardial infarction and sudden cardiac death. The incidence of this condition in general population is between 0.28% and 1.1%, however in pregnant population it accounts for 27% of all MI cases.¹ Mode of presentation is variable and can range from asymptomatic pathology to MI and sudden cardiac death. In the past, sudden cardiac death was the most common presentation with 70% of diagnoses was made at the time of autopsy. 36 years old G3P1⁺¹ at 38 weeks of gestation admitted to delivery suite with spontaneous labour and delivered a live male baby. Two hours after delivery, she started complaining of central chest pain which was radiating to back and left arm along with vomiting. She was haemodynamically stable with normal oxygen saturation. Immediate blood gases, chest x-ray and troponin levels were all normal. However ECG demonstrated inferior ST segment elevation

A Tran thoracic echocardiogram showed inferior regional wall motion abnormality with a 2 cm localised pericardial effusion in the inferio basal area. Coronary angiogram showed a normal left coronary system and extensive dissection extending from the right coronary artery ostium to crux. She was transferred to tertiary unit for emergency surgery and underwent two vessel coronary artery bypass graft (RCA – PDA and RCA – LV), she made a good post operative recovery. She was discharged home with bisoprolol (2.5mg/day) and asprine (75mg/day) and awaiting out patient appointment in 8 weeks.