Email this article Spontaneous anterior coronary interventricular artery dissection in a young woman in the late postpartum period: clinical case
- Authors: Anokhina A.R.1,2, Matyushin G.V.1,2, Ustyugov S.A.1,2, Kharkov E.I.2,3, Savchenko E.A.2,3, Vlasov P.N.1, Okhrimchuk V.V.1, Skorobogatov V.V.1, Popova E.V.1, Karaev E.B.3, Tsibulskaya N.Y.2,3, Ryabkov E.I.3
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Affiliations:
- Regional Clinical Hospital
- Voyno-Yasenetsky Krasnoyarsk State Medical University
- Karpovich Krasnoyarsk Interdistrict Clinical Emergency Hospital
- Issue: Vol 14, No 2 (2023)
- Pages: 115-122
- Section: Case reports
- URL: https://journals.rcsi.science/2221-7185/article/view/146653
- DOI: https://doi.org/10.17816/CS409599
- ID: 146653
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Abstract
BACKGROUND: Cardiovascular complications during pregnancy and postpartum period are rare but often fatal. The causes and mechanisms of the development of such complications are not fully understood. Spontaneous dissection of the coronary artery against the background of the influence of sex hormones is one of the mechanisms for the development of acute coronary syndrome in the postpartum period. The false lumen of the intramural hematoma overlaps the true lumen, causing arterial obstruction, leading to acute myocardial hypoxia. Thus, awareness that the pathophysiology of spontaneous coronary artery dissection differs from that of acute coronary syndrome associated with atherosclerotic plaque rupture is important, and these patients require different treatment approaches. Currently, an unambiguous and precise strategy for this pathology has not been established, which is why difficulties remain in the management of these patients and choosing treatment strategies.
CLINICAL CASE DESCRIPTION: The article describes a complex clinical case of the development of acute myocardial infarction in the postpartum period in a young woman without risk factors against the background of spontaneous dissection of the coronary artery, complicated by cardiogenic shock, which required emergency percutaneous coronary intervention and stenting of the infarct-dependent artery. The postoperative period proceeded with complications, and extracorporeal membrane oxygenation was required. However, an integrated approach and correctly chosen treatment strategies help stabilize the patient’s condition.
CONCLUSION: Currently, no unambiguous and precise strategy of treatment has been established, so difficulties remain in the management of patients and decision making. In our opinion, an individual patient approach should be followed, taking into account the general state of the organism, type and volume of dissection, consequences and complications, and experience and technical capabilities of the clinic.
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##article.viewOnOriginalSite##About the authors
Alena R. Anokhina
Regional Clinical Hospital; Voyno-Yasenetsky Krasnoyarsk State Medical University
Author for correspondence.
Email: alena.anohina.rus@yandex.ru
ORCID iD: 0000-0001-9528-762X
SPIN-code: 9055-9403
cardiologist, department assistant
Russian Federation, 3A Partizana Zheleznyaka Str., 660022, Krasnoyarsk; KrasnoyarskGennady V. Matyushin
Regional Clinical Hospital; Voyno-Yasenetsky Krasnoyarsk State Medical University
Email: matyushin1@yandex.ru
ORCID iD: 0000-0002-0150-6092
SPIN-code: 2398-1156
MD, Dr. Sci. (Med.), Professor, department head
Russian Federation, 3A Partizana Zheleznyaka Str., 660022, Krasnoyarsk; KrasnoyarskSergei A. Ustyugov
Regional Clinical Hospital; Voyno-Yasenetsky Krasnoyarsk State Medical University
Email: ustyugoff-s@yandex.ru
ORCID iD: 0000-0003-3105-1946
SPIN-code: 9045-7075
department head, associate professor
Russian Federation, 3A Partizana Zheleznyaka Str., 660022, Krasnoyarsk; KrasnoyarskEvgeny I. Kharkov
Voyno-Yasenetsky Krasnoyarsk State Medical University; Karpovich Krasnoyarsk Interdistrict Clinical Emergency Hospital
Email: Harkov-50@mail.ru
ORCID iD: 0000-0002-8208-0926
SPIN-code: 1234-3885
MD, Dr. Sci. (Med.), department professor
Russian Federation, Krasnoyarsk; KrasnoyarskElena A. Savchenko
Voyno-Yasenetsky Krasnoyarsk State Medical University; Karpovich Krasnoyarsk Interdistrict Clinical Emergency Hospital
Email: lenasavchenko@rambler.ru
ORCID iD: 0000-0003-4438-1434
SPIN-code: 2742-2621
MD, Cand. Sci. (Med.), associate professor
Russian Federation, Krasnoyarsk; KrasnoyarskPetr N. Vlasov
Regional Clinical Hospital
Email: v.petrn@mail.ru
ORCID iD: 0009-0002-3646-3165
anesthesiologist-resuscitator
Russian Federation, 3A Partizana Zheleznyaka Str., 660022, KrasnoyarskVadim V. Okhrimchuk
Regional Clinical Hospital
Email: vadim_esenin@mail.ru
ORCID iD: 0000-0001-7714-1942
anesthesiologist-resuscitator
Russian Federation, 3A Partizana Zheleznyaka Str., 660022, KrasnoyarskValentin V. Skorobogatov
Regional Clinical Hospital
Email: vaal_z@list.ru
ORCID iD: 0009-0002-6293-4098
cardiologist
Russian Federation, 3A Partizana Zheleznyaka Str., 660022, KrasnoyarskEkaterina V. Popova
Regional Clinical Hospital
Email: veffy@mail.ru
ORCID iD: 0009-0004-8940-7612
cardiologist
Russian Federation, 3A Partizana Zheleznyaka Str., 660022, KrasnoyarskElnur B. Karaev
Karpovich Krasnoyarsk Interdistrict Clinical Emergency Hospital
Email: elnurmed@mail.ru
cardiologist
Russian Federation, KrasnoyarskNatalya Yu. Tsibulskaya
Voyno-Yasenetsky Krasnoyarsk State Medical University; Karpovich Krasnoyarsk Interdistrict Clinical Emergency Hospital
Email: solna33@yandex.ru
ORCID iD: 0000-0003-0122-0884
SPIN-code: 4238-8156
MD, Cand. Sci. (Med.), associate professor
Russian Federation, Krasnoyarsk; KrasnoyarskEvgeny I. Ryabkov
Karpovich Krasnoyarsk Interdistrict Clinical Emergency Hospital
Email: ryabkov.ei@mail.ru
X-ray surgeon
Russian Federation, KrasnoyarskReferences
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