CC BY-NC-ND 4.0 · AJP Rep 2024; 14(01): e34-e39
DOI: 10.1055/s-0043-1778112
Case Report

Bicoastal Spontaneous Coronary Artery Dissection: A Therapeutic Dilemma

1   Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California
2   Department of Maternal-Fetal Medicine, University of California, Irvine, Orange, California
Brian B. Ghoshhajra
3   Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
Nandita S. Scott
4   Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
Afshan B. Hameed
2   Department of Maternal-Fetal Medicine, University of California, Irvine, Orange, California
› Author Affiliations


Due to the potential for severe maternal morbidity and even mortality, pregnancy-associated spontaneous coronary artery dissection (P-SCAD) often presents as a clinical conundrum. While current recommendations encourage coronary interventions when medically indicated even during pregnancy, the hesitation still understandably exists. Meanwhile, given the rarity of the condition, the guidelines for management are still based on expert consensus.

We present a case of P-SCAD in a 38-year-old woman with initial presentation at 28 weeks' gestation and recurrence at 9 days postpartum. A unique complication of this case is its transcontinental nature: the initial event occurred while the patient was on vacation across the country from her home. Questions arose not only with regard to her immediate management and care but also when she would be able to travel and how her complex care would be continued cross-country.

This case raised important questions regarding the antepartum management of acute coronary syndrome (ACS). It also highlights the importance of multidisciplinary care, especially with a cardio-obstetrics team, in the management of P-SCAD and emphasizes the role for universal screening for cardiac diseases in pregnancy.


Dr. Scott receives support from the HOPE and REBIRTH study.

Publication History

Received: 16 September 2023

Accepted: 19 October 2023

Article published online:
23 January 2024

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