Optical coherence tomography guided approach to postpartum coronary artery dissection: a case report

A 42 years old woman (G2, P2) was discharged home, doing fine, after giving birth to a healthy baby after an uncomplicated vaginal delivery. Her cardiovascular risk factors were: a family history of CAD and nicotine addiction, five days post partum she came to our emergency room for acute chest pain, this symptom started the day before with several transient episodes. The EKG showed an ST elevation in the anterior leads. At the echocardiography there was an apical hypokinesia and the ejection fraction was 45-50%. An urgent coronary angiography was performed and it showed a severe lumen narrowing in proximal and middle tract of left anterior descending (LAD) and circumflex arteries (Cx) without stagnation of contrast. (Fig a). The right coronary was normal. The reduction of caliber was irreversible despite the use of intracoronary nitrates.