A 42-year-old woman presents with acute severe substernal chest pain 2 weeks after delivery. She has no traditional cardiovascular risk factors. ECG shows ST elevation in leads V2-V5. Coronary angiography reveals no atherosclerotic disease but a linear dissection flap is noted in the mid-left anterior descending artery. Which is the most likely diagnosis?

• A Spontaneous coronary artery rupture
• B Coronary artery vasospasm (Prinzmetal angina)
• C Spontaneous coronary artery dissection ✓
• D Cocaine-induced myocardial infarction

Explanation

Spontaneous coronary artery dissection (SCAD) is a recognized cause of acute coronary syndrome in young women, classically in the peripartum period, without conventional risk factors. It accounts for up to 35% of ACS cases in women under 50. Diagnosis is by angiography showing an intimal flap or contrast staining of the arterial wall. Coronary vasospasm would show transient spasm with no flap. Cocaine-induced MI typically has risk factors and evidence of atherosclerosis.

Reference: Braunwald's Heart Disease, 12th ed.

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Written and medically reviewed by the StethoPrep medical team.