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

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.