{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T15:39:06Z","timestamp":1783093146654,"version":"3.54.6"},"reference-count":20,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T00:00:00Z","timestamp":1666742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathophysiology"],"abstract":"<jats:p>A spontaneous coronary artery dissection (SCAD) during the postpartum period is a serious medical emergency and the most important non-atherosclerotic cause of coronary artery disease (CAD) in this population. While conservative management is recommended in most SCAD scenarios, cases complicated by hemodynamic instability or cardiogenic shock are particularly challenging and might be amenable only with invasive percutaneous or cardiothoracic surgical management. Herein, we present a case of a 35-year-old otherwise healthy woman that suffered an intense emotional stress event and was subsequently admitted with crushing chest pain to the emergency department. The initial electrocardiogram showed dynamic changes suggesting anterolateral ST-elevation myocardial infarction. She gave birth to a healthy child 3 months before the current presentation. Diagnostic angiography found no occlusive CAD but instead an extensive intramural hematoma originating from the left main artery dissection and extending to the whole left coronary circulation was observed. Hemodynamic instability and hypotension soon followed, and the patient went into cardiogenic shock. The heart team opted for conservative and supportive intensive care management without surgical or percutaneous intervention. This decision ultimately led to the successful extubation of the patient and the achievement of hemodynamic stability. The patient was eventually safely discharged home without any permanent disability.<\/jats:p>","DOI":"10.3390\/pathophysiology29040047","type":"journal-article","created":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T07:17:48Z","timestamp":1666768668000},"page":"610-618","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Conservative Management of Spontaneous Left Main Coronary Artery Dissection (SCAD) Triggered by Emotional Stress in the Late Postpartum Period: Case Report and Pathophysiology"],"prefix":"10.3390","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2700-2121","authenticated-orcid":false,"given":"Jaksa","family":"Zanchi","sequence":"first","affiliation":[{"name":"Division of Interventional Cardiology, Clinic for Heart and Vascular Diseases, University Hospital of Split (KBC Split), Spinciceva 1, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dino","family":"Miric","sequence":"additional","affiliation":[{"name":"Division of Interventional Cardiology, Clinic for Heart and Vascular Diseases, University Hospital of Split (KBC Split), Spinciceva 1, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lovel","family":"Giunio","sequence":"additional","affiliation":[{"name":"Division of Interventional Cardiology, Clinic for Heart and Vascular Diseases, University Hospital of Split (KBC Split), Spinciceva 1, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9843-6309","authenticated-orcid":false,"given":"Anteo","family":"Bradaric Slujo","sequence":"additional","affiliation":[{"name":"Division of Interventional Cardiology, Clinic for Heart and Vascular Diseases, University Hospital of Split (KBC Split), Spinciceva 1, 21000 Split, Croatia"},{"name":"Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mislav","family":"Lozo","sequence":"additional","affiliation":[{"name":"Division of Interventional Cardiology, Clinic for Heart and Vascular Diseases, University Hospital of Split (KBC Split), Spinciceva 1, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duje","family":"Erceg","sequence":"additional","affiliation":[{"name":"Clinic for Anaesthesiology, Reanimatology and Intensive Care, University Hospital of Split (KBC Split), Spinciceva 1, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duje","family":"Orsulic","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital of Split (KBC Split), Spinciceva 1, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4878-8146","authenticated-orcid":false,"given":"Josip A.","family":"Borovac","sequence":"additional","affiliation":[{"name":"Division of Interventional Cardiology, Clinic for Heart and Vascular Diseases, University Hospital of Split (KBC Split), Spinciceva 1, 21000 Split, Croatia"},{"name":"Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1161\/CIRCULATIONAHA.121.058056","article-title":"Spontaneous Coronary Artery Dissection: Insights from Cardiac Magnetic Resonance and Extracoronary Arterial Screening","volume":"145","author":"Androulakis","year":"2022","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e53","DOI":"10.1136\/hrt.2004.038869","article-title":"Spontaneous coronary artery dissection in the postpartum period: Association with antiphospholipid antibody","volume":"90","author":"Krishnamurthy","year":"2004","journal-title":"Heart"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1001\/jama.1973.03220050050012","article-title":"Dissecting hematoma of the coronary artery. 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Interv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1177\/2048872617706502","article-title":"Medical treatment or revascularisation as the best approach for spontaneous coronary artery dissection: A systematic review and meta-analysis","volume":"7","author":"Martins","year":"2018","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.hjc.2021.02.013","article-title":"Invasive versus conservative management in spontaneous coronary artery dissection: A meta-analysis and meta-regression study","volume":"62","author":"Bocchino","year":"2021","journal-title":"Hell. J. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1958","DOI":"10.1161\/CIRCRESAHA.121.318300","article-title":"FMD and SCAD: Sex-Biased Arterial Diseases with Clinical and Genetic Pleiotropy","volume":"128","author":"Kim","year":"2021","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e001933","DOI":"10.1161\/CIRCGENETICS.117.001933","article-title":"Prospective Cardiovascular Genetics Evaluation in Spontaneous Coronary Artery Dissection","volume":"11","author":"Kaadan","year":"2018","journal-title":"Circ. Genom. Precis. Med."}],"container-title":["Pathophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1873-149X\/29\/4\/47\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:03:13Z","timestamp":1760144593000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1873-149X\/29\/4\/47"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,26]]},"references-count":20,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["pathophysiology29040047"],"URL":"https:\/\/doi.org\/10.3390\/pathophysiology29040047","relation":{},"ISSN":["1873-149X"],"issn-type":[{"value":"1873-149X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,26]]}}}