Background: Spontaneous coronary artery dissection (SCAD) is an uncommon but important cause of acute coronary syndrome (ACS), predominantly affecting young women without traditional cardiovascular risk factors. The postpartum period represents a particularly high-risk phase, during which pregnancy-associated SCAD often manifests with severe clinical features such as left main coronary involvement, ventricular dysfunction, or sudden cardiac arrest.
Case Presentation: Twelve days after cesarean delivery, a 39-year-old lady developed acute chest discomfort, loss of consciousness, and cardiac arrest. Electrocardiography showed ST-segment elevation in leads V1–V4 with Q waves in V1–V3 after CPR. Anteroseptal hypokinesia and lowered left ventricular ejection fraction by 25–35% on transthoracic echocardiography. Coronary angiography indicated substantial ostial and proximal left anterior descending artery constriction and mild left main coronary artery involvement, confirming type 2A SCAD. The patient was conservatively treated with dual antiplatelet therapy, beta-blocker, guideline-directed heart failure medication, and vigilant monitoring. Repeat angiography showed near-complete spontaneous coronary dissection repair. The patient was clinically stable and improved left ventricular systolic function over 6 months. The patient was advised to do cardiology follow-up every 6–12 months for evaluation.
Conclusion: This case underscores the potential severity of postpartum SCAD while highlighting favorable outcomes with conservative management. Early recognition of SCAD in young postpartum women presenting with ACS is crucial to avoid misdiagnosis and guide appropriate therapy. The patient’s meaningful recovery in cardiac function (EF rising from 25% to 45%) at follow-up supports conservative treatment and follow up strategies in appropriately selected cases.