Spontaneous Coronary Artery Dissection (SCAD) in Pregnant and Postpartum Women: Risks, Diagnosis, and Medical Malpractice

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Spontaneous Coronary Artery Dissection (SCAD) is a rare and often underdiagnosed condition that predominantly affects women, with pregnant and postpartum women being at particular risk. SCAD occurs when a tear forms in one of the coronary arteries, potentially leading to a heart attack, heart rhythm abnormalities, or sudden death. Understanding the risks, diagnostic challenges, and potential legal recourse is vital for affected families.

The Risk SCAD Poses to Pregnant and Postpartum Women

Pregnancy and the postpartum period are times of significant physiological changes in a woman’s body. These changes can increase the risk of SCAD. Hormonal fluctuations, changes in blood volume and pressure, and the physical stress of childbirth can all contribute to the vulnerability of the coronary arteries. Women with a history of fibromuscular dysplasia, connective tissue disorders, or other vascular issues are at an increased risk. SCAD can lead to cardiac arrest, heart failure, or other life-threatening complications, which is why early diagnosis is critical.

Diagnosis of SCAD

Diagnosing SCAD can be challenging, as its symptoms often mimic those of a typical heart attack, including chest pain, shortness of breath, and sweating. However, unlike atherosclerotic heart attacks, SCAD tends to occur in younger individuals who have fewer cardiovascular risk factors. The gold standard for diagnosing SCAD is coronary angiography, which provides a detailed image of the coronary arteries. Other imaging techniques like intravascular ultrasound or optical coherence tomography can also be used to confirm the diagnosis.

Challenges and Misdiagnosis

Despite advancements in imaging technology, SCAD is frequently misdiagnosed. This is due to a combination of factors including lack of awareness among healthcare professionals, the rarity of the condition, and its tendency to affect a population not typically associated with heart disease. Pregnant and postpartum women might also dismiss their symptoms as normal pregnancy-related discomfort, leading to delayed medical attention.

Women misdiagnosed or not treated promptly for SCAD are at a higher risk of severe complications, including heart failure, recurrence of SCAD, or even death. It is crucial for healthcare providers to maintain a high index of suspicion for SCAD in pregnant and postpartum women presenting with cardiac symptoms, even if they don’t have typical risk factors for heart disease.

Real World Example of Delayed Diagnosis of SCAD Leading to Death

We represent the surviving husband of a young woman who died from undiagnosed Spontaneous Coronary Artery Dissection.  A week before her death she presented to her local emergency department with classic signs of a heart attack – chest pain that radiated into her left arm, sweating, lightheadedness, and nausea.  She reported to the emergency medicine doctor that she was 10 weeks postpartum.  Her blood was tested and showed an elevated level of troponin, which indicates heart damage often seen with heart attacks.  A cardiologist was consulted and considered SCAD.  A CT coronary angiogram was ordered and read as normal.  The patient was discharged home the next day.  She returned to the hospital a week later with similar symptoms, was diagnosed with SCAD, and taken to the heart catheterization lab.  Unfortunately, it was too late and the patient died.  The error in this case was that the patient should have been sent for invasive coronary angiography at the first visit, which is the only diagnostic modality that can rule out SCAD.

Legal Recourse for Affected Families

Women or the families of women who have suffered severe complications or died as a result of a misdiagnosed SCAD may find it beneficial to contact an experienced medical malpractice lawyer. These legal professionals like those at Lupetin & Unatin can help assess whether there was a breach in the standard of care, aiding in securing compensation for medical expenses, lost wages, and emotional distress.

Spontaneous Coronary Artery Dissection poses a significant risk to pregnant and postpartum women, making awareness, prompt diagnosis, and appropriate management crucial. Misdiagnosis is unfortunately common, often leading to devastating outcomes. For affected families, seeking the assistance of an experienced medical malpractice lawyer can provide a path to justice and financial support during a difficult time.

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