Management of Spontaneous Coronary Dissection Complicated by Cardiogenic Shock: A Case Report.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome with debated optimal treatment in the setting of cardiogenic shock (CS). We report a case of a middle-aged woman presenting with out-of-hospital cardiac arrest due to extensive multivessel SCAD. Without evidence for transmural ischemia, we chose conservative treatment with single antiplatelet therapy and heparin. Due to deteriorating hemodynamics, a temporary left ventricular assist device (Impella) was implanted, stabilizing the patient. After weaning the device and initiating heart failure therapy, the patient recovered completely. This case highlights several important considerations for the management of SCAD patients with CS.