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Postpartum Cardiac Arrest in a Young Woman
Cardiovascular Disease SESSION TITLE: Cardiovascular Disease SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM
Postpartum Cardiac Arrest in a Young Woman Elina Levin* Yara Cameron and Ariel Hidalgo East Carolina University Brody School of Medicine, Greenville, NC INTRODUCTION: Spontaneous coronary artery dissection (SCAD) is a relatively rare life-threatening diagnosis in young females. Previously, SCAD was considered very uncommon but recently there has been a surge of this diagnosis. We present a case of SCAD in a postpartum woman.
CARDIOVASCULAR DISEASE
CASE PRESENTATION: 33 year-old African American female presented one week postpartum status post cardiac arrest. Prior to cardiac arrest patient complained of symptoms including emesis and chest pain. She had a ventricular fibrillation arrest and was resuscitated in the field. She achieved ROSC and was sent for further management. Initial work-up included CTA which was negative for PE. Abnormal labs included the following: troponin 0.79, lactic acid 5. EKG showed ST depressions in V2-V4 and prolongation of QTc. ECHO had the appearance of Takatsubo Cardiomyopathy with LVEF 20-25%. Coronary angiogram showed no evidence of coronary artery disease but did show thinning of the LAD with high suspicion for SCAD. Patient was medically managed and sent home with a lifevest. However in less than 24 hours, patient returned to the hospital with new chest pain. Emergent catheterization was performed which indicated spontaneous dissection of the left main with occlusion to the circumflex branch. A two vessel CABG was done. Patient is now improving with no further complaints of chest pain. DISCUSSION: The epidemiology of SCAD is variable. In older studies, the incidence of SCAD and acute coronary syndrome was found to be around 8.7% in young women. In contemporary studies the incidence is quoted at 22-43% 1. This rise has been attributed to better awareness and better imaging. In pregnancy the mechanism for SCAD is potentially multi-factorial with hormonal levels being at the forefront. The gold standard for diagnosis remains coronary angiography however other imaging studies can also be used including intravascular ultrasound and optical coherence tomography. No randomized trials exist for management of SCAD and most management tactics are based on expert opinions. Medical management is initially preferred as high failure rates are reported with attempted revascularization. CONCLUSIONS: SCAD should be considered in the differential in a young female presenting postpartum after cardiac arrest. Increasing awareness for this disease process will result in more studies and better management tactics. Reference #1: Saw J, Mancini GB, Humphries KH. Contemporary Review on Spontaneous Coronary Artery Dissection. Journal of the American College of Cardiology. 2016; 68: 297-312. DISCLOSURE: The following authors have nothing to disclose: Elina Levin, Yara Cameron, Ariel Hidalgo No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2017.08.110
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
80A
[
152#4S CHEST OCTOBER 2017
]
Postpartum Cardiac Arrest in a Young Woman Elina Levin* Yara Cameron and Ariel Hidalgo East Carolina University Brody School of Medicine, Greenville, NC INTRODUCTION: Spontaneous coronary artery dissection (SCAD) is a relatively rare life-threatening diagnosis in young females. Previously, SCAD was considered very uncommon but recently there has been a surge of this diagnosis. We present a case of SCAD in a postpartum woman.
CARDIOVASCULAR DISEASE
CASE PRESENTATION: 33 year-old African American female presented one week postpartum status post cardiac arrest. Prior to cardiac arrest patient complained of symptoms including emesis and chest pain. She had a ventricular fibrillation arrest and was resuscitated in the field. She achieved ROSC and was sent for further management. Initial work-up included CTA which was negative for PE. Abnormal labs included the following: troponin 0.79, lactic acid 5. EKG showed ST depressions in V2-V4 and prolongation of QTc. ECHO had the appearance of Takatsubo Cardiomyopathy with LVEF 20-25%. Coronary angiogram showed no evidence of coronary artery disease but did show thinning of the LAD with high suspicion for SCAD. Patient was medically managed and sent home with a lifevest. However in less than 24 hours, patient returned to the hospital with new chest pain. Emergent catheterization was performed which indicated spontaneous dissection of the left main with occlusion to the circumflex branch. A two vessel CABG was done. Patient is now improving with no further complaints of chest pain. DISCUSSION: The epidemiology of SCAD is variable. In older studies, the incidence of SCAD and acute coronary syndrome was found to be around 8.7% in young women. In contemporary studies the incidence is quoted at 22-43% 1. This rise has been attributed to better awareness and better imaging. In pregnancy the mechanism for SCAD is potentially multi-factorial with hormonal levels being at the forefront. The gold standard for diagnosis remains coronary angiography however other imaging studies can also be used including intravascular ultrasound and optical coherence tomography. No randomized trials exist for management of SCAD and most management tactics are based on expert opinions. Medical management is initially preferred as high failure rates are reported with attempted revascularization. CONCLUSIONS: SCAD should be considered in the differential in a young female presenting postpartum after cardiac arrest. Increasing awareness for this disease process will result in more studies and better management tactics. Reference #1: Saw J, Mancini GB, Humphries KH. Contemporary Review on Spontaneous Coronary Artery Dissection. Journal of the American College of Cardiology. 2016; 68: 297-312. DISCLOSURE: The following authors have nothing to disclose: Elina Levin, Yara Cameron, Ariel Hidalgo No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2017.08.110
Copyright ª 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
80A
[
152#4S CHEST OCTOBER 2017
]