A 34-year-old woman developed life-threatening multivessel spontaneous coronary artery dissection one week after a negative emergency department observation-unit chest pain evaluation.
Case Report (n=1)
No
SCAD should be suspected in young women presenting with recurrent ischemic symptoms, as it can occur even after a recent negative conventional chest pain evaluation.
Spontaneous coronary artery dissection (SCAD) is an underrecognized, non-atherosclerotic cause of acute coronary syndrome (ACS) that disproportionately affects younger women. We present the case of a 34-year-old woman with hypertension who presented to the emergency department with acute chest pain, dyspnea, and vomiting, only one week after a reassuring chest pain evaluation in an observation unit. Prehospital electrocardiography demonstrated arrhythmia with premature ventricular contractions, followed by inferior-lateral ST-T changes on subsequent tracings. These acute findings prompted coronary angiography, which confirmed SCAD. This case highlights that SCAD may occur even after a negative observation-unit evaluation and emphasizes the importance of maintaining a high index of suspicion for SCAD in young women presenting with recurrent ischemic symptoms. In addition, it includes the potential limitations of conventional chest pain algorithms in detecting non-atherosclerotic causes of ACS and calls for potential branchpoints in risk stratification pathways to incorporate additional cardiovascular syndromes.
Bethea et al. (Sun,) conducted a case report in Spontaneous coronary artery dissection (SCAD) (n=1). Conservative medical management was evaluated. A 34-year-old woman developed life-threatening multivessel spontaneous coronary artery dissection one week after a negative emergency department observation-unit chest pain evaluation.