Abstract
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome (ACS) that mainly affects women, particularly during or after pregnancy. CASE SUMMARY: A 38-year-old woman conceived via in vitro fertilization presented at 34 weeks' gestation with chest pain and rising troponin levels (191 ng/L → 5500 ng/L; reference <52 ng/L). Initially patient was elected for medical management. Day later telemetry detected frequent non-sustained ventricular tachycardia, considered a high-risk feature for underlying SCAD. Coronary angiography demonstrated a Type II SCAD of the mid-LAD (≈50% stenosis, TIMI III flow). She was managed conservatively with aspirin and labetalol. Hours later, she developed pre-eclampsia and underwent urgent caesarean section with complete symptom resolution. Two weeks postpartum, she re-presented with an inferior STEMI due to a Type II SCAD of the right PDA (TIMI II flow). Conservative management with temporary intra-aortic balloon pump support led to full recovery and preserved left-ventricular function. DISCUSSION: This biphasic case highlights SCAD's propensity for recurrence in the peripartum period and supports conservative management when coronary flow is maintained. Reference to the 2025 ESC Guidelines for Acute Coronary Syndromes underscores the role of individualized, multidisciplinary care.