Coronary Artery Dissection in a Woman With Previous Systemic Lupus Erythematosus Using Oral Contraceptive Pills

  • Hadiseh Kavandi Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
  • Ali Golmohammadi Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
  • Robabeh Sadeghi Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
  • Reza Hajizadeh Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran.
Keywords: Coronary artery dissection, Spontaneous, Percutaneous coronary intervention, Right coronary artery

Abstract

Spontaneous coronary artery dissection (SCAD) is a rare but devastating cause of the acute coronary syndrome, malignant arrhythmias, and sudden cardiac death. It mainly affects young, middle-aged and otherwise healthy women. Oral contraceptive pills (OCP) and connective tissue disease are known as predisposing factors for SCAD. Here, we present a 43-year-old woman with a history of systemic lupus erythematosus (SLE), using OCP came with typical chest pain. With diagnosing inferior ST-elevation myocardial infarction, fibrinolytic therapy was done which aggravated her chest pain. Finally, the diagnosis of SCAD was proven by angiography and stenting was done. On the 6th day of her hospitalization, tachycardia occurred again, and trans-esophageal echocardiography was performed for the patient who showed partially flail anterior mitral leaflet. She was discharged from hospital after mitral valve replacement. This is a great dilemma in the management of a young woman with a history of connective tissue disease or vasculitis, like our patient who wants a contraceptive method.

References

Maeder M, Ammann P, Angehrn W, Rickli H. Idiopathic spontaneous coronary artery

dissection: incidence, diagnosis and treatment. Int J Cardiol. 2005;101(3):363-9.

Salari A, Gholipur M, Rezaeidanesh M, Barzigar A, Rahmani S, Pursadeghi M, et al. A

-Year-Old Woman with Coronary Artery Dissection Two Weeks after Abortion. The Journal

of Tehran University Heart Center. 2016;11(2):98-101.

Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ, et al. Clinical features,

management, and prognosis of spontaneous coronary artery dissection. Circulation.

;126(5):579-88.

McCann AB, Whitbourn RJ. Spontaneous coronary artery dissection: a review of the

etiology and available treatment options. Heart and vessels. 2009;24(6):463-5.

Patrignani A, Purcaro A, Gabrielli G, Ciampani N. Spontaneous coronary artery

dissection and elevated levels of lipoprotein(a) in a young man: a causal association? Journal

of cardiovascular medicine (Hagerstown, Md). 2011;12(6):446-8.

Pan AL, Fergusson D, Hong R, Badawi RA. Spontaneous Coronary Artery Dissection

following Topical Hormone Replacement Therapy. Case reports in cardiology.

;2012:524508.

Zehir R, Karabay CY, Kocabay G. Myocardial infarction and spontaneous dissection of

coronary artery due to oral contraceptive. Journal of cardiovascular medicine (Hagerstown,

Md). 2011;12(6):448-50.

Vanzetto G, Berger-Coz E, Barone-Rochette G, Chavanon O, Bouvaist H, Hacini R, et al.

Prevalence, therapeutic management and medium-term prognosis of spontaneous coronary

artery dissection: results from a database of 11,605 patients. European journal of cardio-

thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

;35(2):250-4.

Lichy C, Pezzini A, Becker C, Arnold ML, Brandt T, Kloss M, et al. No evidence for a role

of thyroid autoimmunity in the pathogenesis of cervical artery dissection. Cerebrovascular

diseases (Basel, Switzerland). 2009;28(2):203-4.

Magarkar V, Lathi P. A case of spontaneous coronary artery dissection in early

pregnancy managed by PCI. Indian heart journal. 2016;68 Suppl 2:S25-s7.

Published
2019-01-22
How to Cite
1.
Kavandi H, Golmohammadi A, Sadeghi R, Hajizadeh R. Coronary Artery Dissection in a Woman With Previous Systemic Lupus Erythematosus Using Oral Contraceptive Pills. Acta Med Iran. 56(12):815-817.
Section
Case Report(s)