OH MI, NOT AGAIN: RECURRENT SPONTANEOUS CORONARY ARTERY DISSECTION IN A POST-PARTUM FEMALE

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Spontaneous coronary artery dissection (SCAD) is a of an epicardial that non-iatrogenic, non-traumatic, and not associated with atherosclerosis. Pregnancy-related SCAD (P-SCAD) accounts for approximately 10% all cases higher incidences ST-elevation myocardial infarction (STEMI), cardiogenic shock, death. CASE PRESENTATION: A 34-year-old female presented chest discomfort five days after induction labor at 35 weeks due to preeclampsia. Troponin was 55.38. Electrocardiogram (ECG) showed STEMI in leads V2-4. Coronary angiography (CA) mid-left anterior descending (LAD) occlusion. Subsequent percutaneous intervention (PCI) stent placement resulted Thrombolysis Myocardial Infarction (TIMI) 3 flow. She transferred the intensive care unit on dual antiplatelet therapy. Transthoracic echocardiogram (TTE) left ventricular ejection fraction 30%, apical akinesis, without thrombus (LVT). Seven later, patient had recurrent pain, repeat ECG demonstrated inferior leads. Repeat CA proximal circumflex (LCx) occlusion marginal branch. During PCI deployment, extended LAD requiring additional stenting. Right heart catheterization revealed cardiac output index 2.8 L/min 1.7 L/min/m2 respectively, Impella milrinone support. TTE persistent but now visualized LVT (Figure 1). The initiated discharged triple therapeutic anticoagulation clopidogrel, aspirin, apixaban. DISCUSSION: majority P-SCAD occurs during third trimester or post-partum, often has more severe features compared unrelated pregnancy. While conservative treatment first-line, recommended STEMI, arrest. reported rates 0-37%, second event occurring within first event, as seen our patient. This case unique recurrence involved multiple vessels, suggesting necessity monitor patients longer. CONCLUSIONS: Pregnancy places females high risk rapidly progressive SCAD. As by this case, may involve increasing akinesis thrombi formation, subjecting menstruating therapy anticoagulation. Because life-threatening disease, prevention protocols pre, peri, post-partum must become clearer. In conclusion, it imperative stratify presenting acute syndrome based pregnancy history ensuring long-term cardiovascular follow-up. REFERENCE #1: Tweet, M. Associated With Pregnancy. JACC. 2017 DISCLOSURES: No relevant relationships Stefanie Gallagher, source=Web Response Katie Hawthorne, Tripti Kumar, Gwyneth McNeill, Jacob Reiss,