A woman in her early 40s, gravida 3, para 3, with a history of migraines and recurrent preeclampsia and who was 11 weeks post partum presented with acute pleuritic chest pain, shortness of breath, and nausea that started several hours after a flight from Florida to New York City. She was noted to have tachycardia (110 beats/min) and hypoxemia (90% receiving room air) with a blood pressure of 106/81 mm Hg. Cardiac, respiratory, and pulse examination results were unremarkable. She denied any clear physical or emotional triggers preceding presentation. Before presentation, the patient reported good health with satisfactory employment-mandated routine physical examinations. She denied a history of smoking, alcohol, or illicit drug use. She was not taking hormonal birth control or hormone therapy. Laboratory values demonstrated a normal complete blood cell count and metabolic panel. Chest radiograph results were unremarkable. A computed tomographic chest scan excluded pulmonary embolism but suggested pulmonary and interstitial edema. Results of an electrocardiogram revealed sinus tachycardia with premature ventricular contractions, subcentimeter ST-segment elevation in leads I and aVL and 1-mm ST-segment depression in leads II, III, aVF, and V5 through V6. Initial high-sensitivity troponin was 110 000 ng/mL (to convert to micrograms per liter, multiply by 1). Results of cardiac point-of-care ultrasonography demonstrated a severely reduced left ventricular ejection fraction of 40%, with hypokinesis of the anterolateral and posterior walls. Emergent cardiac catheterization revealed spontaneous coronary artery dissection (SCAD) of the left main coronary artery (Figure 1 and Video).
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Chayakrit Krittanawong, MD, Cardiology Division, NYU School of Medicine, Section of Cardiology, 550 First Ave, New York, NY 10016 (email@example.com).
Published Online: June 28, 2023. doi:10.1001/jamacardio.2023.0740
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
Additional Contributions: We thank Sunil V. Rao, MD (New York University Langone Health System), for his insightful comments and suggestions, for which he did not receive compensation.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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