年輕孕婦自發性冠狀動脈剝離之病例報告

A Case Report of Spontaneous Coronary Artery Dissection in a Young Pregnant Woman

自發性冠狀動脈剝離（spontaneous coronary artery dissection，SCAD）是一種罕見的急性冠狀動脈症候群，在懷孕期間發生更為罕見，約佔所有妊娠相關心肌梗塞的1-4%。我們報告1例27歲懷孕33週的孕婦，因安胎治療期間出現胸悶、左臂放射性疼痛而就診。初始心電圖無明顯異常，但肌鈣蛋白（troponin）顯著升高。病人先接受抗凝血治療（anticoagulant therapy），後因症狀加劇，並出現典型心電圖變化，緊急進行冠狀動脈血管造影確診右冠狀動脈自發性剝離，合併血栓形成。成功進行經皮冠狀動脈介入治療，置放3支塗藥支架。病人於懷孕37週剖腹產，母女均安。懷孕期間的自發性冠狀動脈剝離診斷困難，需要高度警覺性。及時的血管造影和介入治療，可以挽救母親和胎兒的生命。多學科團隊合作對於治療成功極為重要。

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome, with pregnancy-associated SCAD (P-SCAD) accounting for 1-4% of all pregnancy-related myocardial infarctions. We report the case of a 27-year-old woman at 33 weeks’gestation who presented with chest discomfort and left arm radiating pain during tocolytic therapy. The initial electrocardiogram showed no significant abnormalities. However, troponin I levels were markedly elevated. The patient initially received anticoagulation therapy but subsequently developed severe chest pain with characteristic electrocardiographic changes. Emergency coronary angiography revealed spontaneous dissection of the right coronary artery with concurrent thrombosis. Successful percutaneous coronary intervention was performed with the placement of three drug-eluting stents. The patient delivered a healthy baby at 37 weeks’gestation, and both mother and child remained well at follow-up. P-SCAD presents a diagnostic challenge requiring high clinical suspicion. Timely angiography and intervention can be life-saving for both mother and fetus. A multidisciplinary team approach is crucial for successful management.