Peripartum Dissection of the Right Coronary Artery

This 35-year-old woman was evaluated after giving birth. Her electrocardiogram showed transient ST depressions in leads II, III, aVF, and Vthrough V. Evaluation included intravascular ultrasound imaging. A 35-year-old woman was evaluated for presyncope several days after giving birth. The results of physical examination were unremarkable, but her electrocardiogram showed transient ST depressions in leads II, III, aVF, and V 4 through V 6 . An echocardiographic stress test performed with the use of dobutamine showed wall-motion abnormalities on provocation. A coronary angiogram showed normal coronary arteries, with haziness at the right coronary arterial ostium (Panel A, arrow). Subsequent evaluation by intravascular ultrasound imaging showed a nonocclusive ostial dissection (Panel B, arrow; and Video Clip 1) with a free-moving flap. A conservative therapeutic approach was chosen, and . . .