Defining the Cause of Postpartum Myocardial Infarction - Another Use for Optical Coherence Tomography.

Chest pain in a young postpartum female can have many causes; however, when associated with ST elevation on ECG, spontaneous coronary artery dissection (SCAD) should be high on the list. Coronary angiography remains the first step in delineating the coronary lesion in suspected cases of SCAD and optical coherence tomography (OCT) can be crucial when the angiographic appearance remains uncertain. We present a case of a young postpartum female with ST elevation myocardial infarction (STEMI). Coronary angiography revealed a dilated part of the middle segment of the left anterior descending (LAD) artery while intramural haematoma (IMH) of the coronary artery wall was found on OCT, which confirmed the clinically suspected diagnosis of SCAD. LEARNING POINTS: SCAD is a rare entity and considered the most common cause of STEMI in the postpartum state.OCT is an intracoronary imaging modality utilizing light waves for image acquisition with high resolution, assisting in clinical decision-making regarding the pathophysiological mechanism of an acute coronary syndrome (ACS).In suspected cases of SCAD, coronary angiography remains the first diagnostic line and OCT can be crucial in confirming an ambiguous angiographic appearance. © EFIM 2020.