Just a week after delivering her baby, a 28-year-old woman collapsed while climbing a flight of stairs at her home and was rushed to our emergency room. What appeared to be routine post-delivery fatigue quickly escalated into a medical emergency when she developed severe breathlessness and was unable to continue walking.We performed an electrocardiogram (ECG), but it did not show the typical changes seen in a heart attack. Blood tests were equally inconclusive, with her troponin levels — a protein released when the heart muscle is damaged — not significantly elevated.However, her severe breathlessness was out of proportion to what would be expected after childbirth. So we performed an urgent echocardiogram (Echo), which revealed that her heart’s pumping function had become markedly weak. Given that she was just one week postpartum, doctors initially suspected peripartum cardiomyopathy, a condition that weakens the heart muscle during the last month of pregnancy or within six months after delivery. But because her clinical picture did not entirely fit the diagnosis, the team pursued further investigations.A coronary angiogram ultimately revealed the real cause — a 95% blockage in the left anterior descending (LAD) artery, one of the heart’s most important blood vessels, caused by a tear in its walls, reducing blood flow to the heart muscle and potentially causing a heart attack. Clinically, we call it Spontaneous Coronary Artery Dissection (SCAD).For this reason, cardiologists often refer to a major blockage in the LAD as particularly dangerous, as it can result in heart failure, dangerous rhythm disturbances or even sudden cardiac death if left untreated.How hormonal changes can trigger heart vessel tearsUnlike conventional heart attacks, which are usually caused by cholesterol plaques building up over many years, SCAD occurs when a tear develops within the wall of a coronary artery. Pregnancy and the postpartum period are associated with profound hormonal and immunological changes. These hormonal fluctuations can weaken the structure of blood vessel walls by altering collagen and other connective tissue components, making them more vulnerable to injury. Inflammation and immune-related changes that occur after delivery may further affect the integrity of the arteries.In some women, bleeding occurs within the layers of the artery wall, forming a collection of blood known as an intramural haematoma. This causes the artery wall to thicken from within, narrowing the channel through which blood normally flows. In other cases, a tear develops in the inner lining of the artery, allowing blood to enter the vessel wall and create a false channel. Both mechanisms compress the artery, reducing blood flow to the heart muscle and potentially triggering a heart attack.Story continues below this adIn this patient, the process resulted in a 95% narrowing of the LAD artery, severely restricting blood supply to the heart.How is SCAD different from peripartum cardiomyopathy?Peripartum cardiomyopathy primarily affects the heart muscle itself and is thought to result from a combination of hormonal, inflammatory, immune and genetic factors. There are no blocked coronary arteries.SCAD, on the other hand, is a disease of the coronary arteries. Distinguishing between the two is critical because treatment strategies differ significantly.Treatment depends on the severityMany patients with SCAD can be managed conservatively because the artery often heals naturally over time. Doctors may prescribe medications and closely monitor recovery without immediately inserting a stent.Story continues below this adHowever, if there is persistent chest pain, ongoing reduced blood flow, or a severe blockage involving a major artery such as the LAD, procedures like coronary angioplasty and stenting may become necessary to restore blood flow. We had to do one on our patient.Recognising the warning signsCardiologists say the case highlights the need for greater awareness of heart disease during the postpartum period. Women who develop persistent breathlessness, chest discomfort, unexplained fatigue, palpitations, dizziness, fainting, or swelling of the legs after childbirth should seek medical attention immediately rather than attributing these symptoms solely to the demands of caring for a newborn.Early evaluation with an ECG, echocardiogram, cardiac biomarkers, and, when indicated, coronary angiography can help identify life-threatening conditions that may otherwise be overlooked.Early diagnosis and prompt medical intervention significantly improve the chances of recovery, allowing many women to regain normal heart function and return to healthy lives.Story continues below this ad(Dr Shetty is lead cardiologist and medial director, Sparsh Hospital, Bengaluru)