Pregnancy After Spontaneous Coronary Artery Dissection (SCAD): a 2020 Update
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(2020) 22:56
Pregnancy and Cardiovascular Disease (N Scott, Section Editor)
Pregnancy After Spontaneous Coronary Artery Dissection (SCAD): a 2020 Update Esther Davis, MBBS, DPhil1,2 Malissa J. Wood, MD1,2,* Address *,1 Cardiology Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA Email: [email protected] 2 Harvard Medical School, Boston, MA, USA
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Pregnancy and Cardiovascular Disease Keywords Spontaneous coronary artery dissection I SCAD I Pregnancy I Pregnancy-associated spontaneous coronary artery dissection I Recurrence risk I Pregnancy-associated myocardial infarction
Abstract Purpose of review Spontaneous coronary artery dissection (SCAD) is a disease which affects a predominantly female and relatively young population, some of whom have not yet completed their reproductive lives. SCAD has traditionally been considered a contraindication to future pregnancy due to concerns about the risk of recurrence and the high-risk phenotype associated with pregnancy-associated SCAD (P-SCAD). This review summarizes recent advancements in the understanding of pregnancy and reproductive health after SCAD. Recent findings Although traditionally under-recognized and underdiagnosed, the importance of SCAD as a unique clinical entity is now recognized in a growing number of expert guidelines and consensus documents which provide advice on the management of pregnancy. Recent data, although insufficient to alter current management recommendations, offers hope that the recurrence rate in subsequent pregnancies may be lower than previously believed. Summary Pregnancy and reproductive health for women after SCAD is a complex area with relatively limited data to guide management decisions. At present, there is insufficient data to challenge the traditional assumption that subsequent pregnancy should be avoided. Where pregnancy is pursued, thoughtful multidisciplinary management in expert women’s heart health centres is vital. Going forward, increased experience in the management of all aspects of reproductive health in these women will hopefully provide data to allow more accurate understanding of risks and optimal management in this population.
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Curr Treat Options Cardio Med
(2020) 22:56
Case-introduction A 34-year-old woman presents for routine cardiology follow-up. Her history is significant for a spontaneous coronary artery dissection at age 32 and episodic migraines. The SCAD occurred 2 weeks following a first trimester miscarriage when she presented to a local hospital emergency department with a 1-hour history of retrosternal chest pain which radiated to the jaw and both arms. ECG showed anterior T wave inversions and troponin-T peaked at 0.99 ng/mL (normal G 0.03 ng/mL). Subsequent coronary angiogram revealed multivessel SCAD involving the LAD, first diagonal and third obtuse marginal. She was managed conservatively and ultimately discharged from hosp
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