EKG of the Week – 5 ANSWERS

This EKG is certainly concerning.  There is impressive ST elevation in AVR and diffuse depressions. There is also STE in V1.  Without any history, being handed this EKG, I’d be worried about a left main coronary artery occlusion.  Why would a 22 yo F who gave birth 3 days ago have an EKG that looks like this? 

This is concerning for something called SCAD or spontaneous coronary artery dissection.  What is SCAD?

     SCAD is a non-atherosclerotic, non-traumatic cause of coronary artery dissection.  it is the MOST COMMON cause of MI in pregnancy or the postpartum period.  25% of acute MIs in pregnancy are due to SCAD, whereas in nonpregnant women it is responsible for <1%.  If you have an otherwise healthy person who presents like a 50s yo smoking, hypertensive, diabetic with crushing substernal chest pain and diaphoresis, think about SCAD.

How do you diagnose it?  Call a CODE STEMI and the patient goes to the Cath lab.  

EM docs does an excellent write upon SCAD: Spontaneous Coronary Artery Dissection