Spontaneous Coronary Artery Dissection (SCAD) is a rare cardiac emergency condition that occur due to spontaneous separation of the coronary arterial walls with or without intramural hematoma, causing acute coronary syndrome.
A 42 year-old Malay female who just delivered her fourth baby 6 weeks ago, with no risk factors of cardiovascular disease presented to emergency department with acute onset of central chest pain. Vital signs and physical examination was otherwise unremarkable. An electrocardiography showed dynamic ischemic changes in antero-lateral lead. Cardiac marker showed raise troponin T level. She was treated as NSTEMI. Angiography and intravascular ultrasound confirmed the present of spontaneous dissection + intramural haematoma in the mid left anterior descending coronary artery causing 90% coronary stenosis. Drug eluting stent was placed successfully at the lesion with no residual stenosis.
The prevalence of SCAD has been reported to be as high as 1% to 4% of ACS overall 3 and up to 80% of the cases happened in female4. SCAD patients are typically in young women who do not have risk factors for atherosclerosis. Although the pathophysiology of SCAD is not clearly understood, few related conditions has been identified such as pregnancy and postpartum period, fibromuscular dysplasia, extreme physical exertion or emotional stress, coronary vasospasm, hypertensive crisis, connective tissue disorders, and cocaine used.
Acute myocardial infarction is not solely due to ruptured atherosclerosis plaque. Consider SCAD in young female who presented with angina without cardiovascular risk factors.