• Makoto Takeuchi, Takenori Okada, Yuki Ikegami, Yumiko Nakamoto, Naomi Idei, and Norihiko Ohashi.
• Department of Cardiology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan.
• Medicine (Baltimore). 2021 May 7; 100 (18): e25775e25775.

RationaleThe relationship between spontaneous coronary artery dissection (SCAD) and takotsubo syndrome (TTS) remains unclear. Coexistence of SCAD and TTS has been reported in the literature. However, the relationship between these two diseases has not yet been elucidated.Patient ConcernsA 36-year-old breastfeeding woman was brought to our hospital 52 days after cesarean section because of discomfort in her left arm and convulsions.DiagnosesShe was diagnosed of acute myocardial infarction (AMI). The convulsions were attributed to lethal arrhythmia.InterventionsAn immediate coronary angiography revealed that her left anterior descending artery (LAD) was Type 2a SCAD, but with no flow limitation. In addition, a 12-lead electrocardiogram (ECG) revealed improvement in ST-elevation. We chose the conservative treatment according to the patient's needs.OutcomesConservative treatment was unsuccessful. She developed another acute myocardial infarction requiring another percutaneous coronary intervention (PCI) during hospitalization. From the course of hospitalization, we suspected the coexistence of SCAD and TTS.LessonsWhen we treat patients with SCAD, we should consider the possibility of coexistence of TTS and confirm left ventricular wall motion. Patients with SCAD may require invasive treatment, hence, should be monitored for a while. An urgent strategy for managing patients with SCAD who require PCI should be established.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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