دایسکشن سکته قلبی بعد زایمان در زمینه پره اکلامسی

Introduction:Pre-eclampsia is multisystem placentally mediated disease, which usually arises after 32 weeks of gestation and classically presents with hypertension and proteinuria. Pre-eclampsia affects 2% to 8% of all pregnancies worldwide .Women with history of pre-eclampsia are at increased risk of future cardiovascular complications such as coronary artery disease.Postpartum spontaneous coronary artery dissection (SCAD) is rare cause of acute myocardial infarction. Survivors of the initial event generally have good long-term prognosis.The frequency of peripartum or postpartum SCAD is around in 100,000 pregnancies.The exact etiology is unknown.Case report 1: 37 years old woman,refered with post partum uncontrolled HTN(150/103) and tachycardia(120/130). she was anxious and expressed frequently passing away feeling.PMH included varicose veins, preeclampsia since second trimester with uncontrolled HTN during her pregnancy that led to preterm parturition.although family history was positive for HTN and cardiac disease ,she did nt express about special HTN back ground before her pregnancy.Echocardiography revealed 50%EF range also mild TI and LVH were visible.,exercise electrocardiography was abnormal but due to her age and situation;weight loss recomended and as she didn breastfed her infant, ASA,Metohexal Ropixon were advised,Metohexal was prescribed for controlling HTN.after amonth she experienced typical/untypical pain in her chest and left upper limb after taking some heavy burden. baclofen added to her prescription to distinguish musculoskeletal pain but yet she had intermittently left side pain during daily activity.A month later severe chest and left hand pain reappeared associated with uncontrolled HTN(14/9.5).EF range had been decreased to 45_50% but ST depression was evident on antrior to lateral leads of ECG,that could be NSTEMI manifestation.despite all her symptomes,she refused admission in hospital Plavix,ASA,Rosuvastatin,sublingual nitroglycerin Enoxaparin 6000 iu SQ,BD;were added to her daily consumed medicine.two days later angiography performed since severe unreliefing pains and decreased EF(30%) near total obstruction of LAD (99%)was revealed as result.administered angioplasty was successful.Her symptomes get controlled and EF increased to Nl level.(50%)although she express about vague pains pending activity.Result:Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal.the patient had peri partum HTN whereas in gestational hypertension blood pressure elevation is only present during pregnancy.Her symptoms explained rare case that maybe preeclampsia was predisposing factor directed her to CAD( coronary artery dx)and eventually led to NSTEMI.Also in similar cases dissection remains viable issue to consider