When coronary artery dissection (SCAD) occurs in a female patient who is pregnant or breastfeeding, pharmacotherapy decisions require careful individual evaluation. Standard treatment principles still apply, but agent selection must account for maternal, fetal, and infant safety.
This protocol addresses coronary artery dissection in women who are pregnant or lactating (breastfeeding). Special consideration must be given to post-SCAD pharmacotherapy recommendations for women in this setting, as the physiological context directly influences which therapies are appropriate.
Despite the unique challenges of pregnancy and lactation, the core principles of SCAD management remain consistent: early diagnosis, careful confirmation of the dissection, and conservative management when there is no evidence of ongoing ischemia, hemodynamic instability, or particularly high-risk anatomy. Medical therapy is applied with specific agents selected for their established compatibility with pregnancy or breastfeeding.
Special consideration must be given to post-SCAD pharmacotherapy recommendations for women who are pregnant or lactating.
Despite the special situation presented by pregnancy, the principles of SCAD management are largely the same as for non–pregnancy-associated SCAD, namely maintenance of a strong suspicion to ensure that the diagnosis is not missed, early and careful angiography to avoid iatrogenic dissection and to confirm the diagnosis, and aiming for conservative management if there is no evidence of ongoing ischemia or infarction, hemodynamic instability, or particularly high-risk anatomy.
DOI: 10.1161/cir.0000000000000564
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