A CASE OF SCAD (SPONTANEOUS CORONARY ARTERY DISSECTION) IN A YOUNG FEMALE WITH RECURRENT INTRA CTA BLE NAUSEA AND VOMITING

Document Type

Conference Proceeding

Publication Date

7-17-2025

Publication Title

J Gen Intern Med

Keywords

carvedilol, troponin, adult, cannabis use, case report, Caucasian, cholecystectomy, clinical article, complication, conference abstract, connective tissue disease, coronary angiography, coronary artery dissection, drug therapy, echocardiograph, echocardiography, electrocardiogram, electrocardiography, endometriosis, endoscopy, female, follow up, gallbladder disease, hemodynamics, heparinization, hormonal therapy, hospitalization, human, intravenous drug administration, nausea and vomiting, physical stress, posttraumatic stress disorder, psychological aspect, ST segment elevation, stomach paresis, T wave inversion, Takotsubo cardiomyopathy, therapy, thorax pain, vomiting

Abstract

CASE: A 30-year-old Caucasian female with a history of intractable nausea and vomiting, endometriosis on hormonal therapy, and PTSD presented with recurrent severe nausea, vomiting, and new-onset chest pain. Her history included multiple hospitalizations for similar symptoms, thought to be related to marijuana use, gallbladder dysfunction (status-post cholecystectomy), or gastroparesis. In the past the patient had a positive gastric empyting study. Endoscopy was performed and showed no clear pathology, and her symptoms persisted. During hospitalization, she started having chest pain. Her electrocardiogram revealed ST-segment elevations and T-wave inversions in the inferior leads, prompting immediate cardiac evaluation. Troponin levels were markedly elevated. Coronary angiography confirmed SCAD involving three vessels. She was initiated on IV heparin therapy, which was discontinued after 24 hours due to resolution of chest pain and hemodynamic stability. She was discharged on carvedilol and antiplatelet therapy, with follow-up for repeat echocardiogram plannedFurther evaluation revealed no significant underlying connective tissue disorder or vasculopathy. Her SCAD was attributed to hormonal therapy for endometriosis, physical stress from nausea and vomiting, and potential stress-induced cardiomyopathy, given her psychological history. IMPACT/DISCUSSION: This case highlights the importance of maintaining a high suspicion for life-threatening conditions like spontaneous coronary artery dissection (SCAD) in young patients. Particularly women, who present with atypical symptoms such as intractable nausea and vomiting. Hormonal therapy and physical stress from recurrent severe vomiting may have contributed to the pathogenesis in this patient. SCAD represents a diagnostic challenge in young females, particularly when co-existing with atypical symptoms such as recurrent intractable nausea and vomiting. This case emphasizes the need for multidisciplinary collaboration in evaluating young patients with chest pain. SCAD represents a diagnostic challenge in young females, requiring a holistic approach to patient care. CONCLUSION: This case recognizes the need for increased awareness of SCAD in younger female patients presenting with atypical chest pain, especially in the context of hormonal therapy, physical stress, and psychological factors. Timely recognition and intervention can mitigate complications and improve outcomes. It also highlights the importance of addressing both physical and mental health factors to achieve a comprehensive care plan.

Volume

40

First Page

S97

Last Page

S98

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