A breastfeeding woman with spontaneous coronary artery dissection and possible takotsubo syndrome

Abstract

Rationale: The relationship between spontaneous coronary artery dissection (SCAD) and takotsubo syndrome (TTS) remains unclear. Coexistence of SCAD and TTS has been reported in the literature. However, the relationship between these two diseases has not yet been elucidated. Patient concerns: A 36-year-old breastfeeding woman was brought to our hospital 52 days after cesarean section because of discomfort in her left arm and convulsions. Diagnoses: She was diagnosed of acute myocardial infarction (AMI). The convulsions were attributed to lethal arrhythmia. Interventions: An immediate coronary angiography revealed that her left anterior descending artery (LAD) was Type 2a SCAD, but with no flow limitation. In addition, a 12-lead electrocardiogram (ECG) revealed improvement in ST-elevation. We chose the conservative treatment according to the patient's needs. Outcomes: Conservative treatment was unsuccessful. She developed another acute myocardial infarction requiring another percutaneous coronary intervention (PCI) during hospitalization. From the course of hospitalization, we suspected the coexistence of SCAD and TTS. Lessons: When we treat patients with SCAD, we should consider the possibility of coexistence of TTS and confirm left ventricular wall motion. Patients with SCAD may require invasive treatment, hence, should be monitored for a while. An urgent strategy for managing patients with SCAD who require PCI should be established.

Recurrent Spontaneous Coronary Artery Dissection: Association with Takotsubo Syndrome and Fibromuscular Dysplasia; Comprehensive Review

“…Coexistence of SCAD and TS in the same patients have been reported in case reports [13][14][15][16][17][18][19][20], series of cases [21] and in some studies [22]. These associations have been deemed as SCAD misdiagnosed as TS by some authors [23] or as TS triggered by SCAD by other investigators [8,21,22,41].…”

“…The increase in knowledge and recognition of the disease has resulted in novel information that may affect the future management of these patients. Coexistence of SCAD and Takotsubo syndrome (TS) in the same patients has been reported in case reports [13][14][15][16][17][18][19][20], series of cases [21] and in some studies [22]. Some investigators still believe that the association of SCAD and TS is a misdiagnosis [23].…”

“…Main et al [26] have also reported on early SCAD extension and late de novo SCAD recurrence by studying 43 patients with recurrent SCAD. Nine (20.9%) of the 43 patients had extension of SCAD at a median time of five (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) days from index presentation. All SCAD extension patients had worsening of the index SCAD lesions with 5/9 involving extension to the adjacent segments.…”

“…The first report on the association of SCAD and TS was published in 2013 in a woman with LAD-SCAD with mid-apical ballooning where the reversible myocardial stunning extended beyond the limited MI caused by LAD-SCAD [ 13 ]. During the last few years, series of cases, and even some studies of ACS including SCAD triggering TS have been reported [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Duran et al .…”

Spontaneous coronary artery dissection: a focus on post-dissection care for the vascular medicine clinician

“…Theoretically, hormonal changes during breastfeeding may potentiate the effects of the postpartum period and increase risk for SCAD ( 57 , 58 ). One study reported that about 3% of women in a cohort were breastfeeding at the time of SCAD ( 14 ).…”