The patient checked in the sector of Cardiovascular Rehabilitation in the Study Centre in Physiotherapy and Rehabilitation of Faculdade de Ciencias e Tecnologia - UNESP, in Presidente Prudente, Brazil, following medical recommendation, in September 2011. She was 36 years old, white, primigravida, diagnosed with SCAD ten days postpartum, neither showing previous cardiopathy nor history of drug use, no problems during prenatal, and she was subjected to a cesarean delivery in April 2010.
Ten days after delivery, the patient had a sudden illness and was sent to Intensive Care Unit, where she suffered an Acute Myocardial Infarction (AMI). A Diagnostic Cardiac Catheterization was performed followed by a Therapeutic Cardiac Catheterization, on which an "STENT" implant was placed in the anterior descending coronary artery.
One month after the AMI the patient was subjected to another Diagnostic Cardiac Catheterization and obstruction of 90% "intra-STENT" was found; the diagonal artery (DA) totally obstructed in the middle third and the circumflex artery (CxA) showing a target lesion of 80% in the middle third.
In November 2010 the patient was subjected to a Cardiac Resonance, and borderline left ventricular function equal to 52% was found due to a hypokinesia of the basal anterior and lateral walls of the left ventricle. An Angiotomography showed the presence of significant single-vessel luminal reduction; there was in CxA the presence of dissection of the distal left main coronary artery and DA proximal; the presence of pervious "STENT" and no luminal reduction in DA were also found.
In December 2010 the patient submitted to coronary artery bypass surgery (CABG) with the placement of a mammary artery bypass and coronary artery bypass.
In January 2011 the Angiotomography was re-done and the venous graft was occluded in its emergency of anterior face of the ascending aorta. In July 2011 an exam stress/rest Myocardial was performed in which a persistent hipoperfusion in the anterolateral wall of the left ventricle was observed, with discreet component of transience associated in the basal area beyond a low degree depressed contractile function of the left ventricle.
A Holter was done, in which dominant sinus rhythm, absence of arrhythmias and heartbeat rate varied from 48 to 110 beats per minute (bpm), with an average of 70 bpm. The Ecocardiogram found mild mitral regurgitation and ejection fraction of 63%.
In the clinical examination, in September 2011, she reported great limitation in performing daily life activities, tiredness, dizziness when lowering and standing up, the right upper limb was weak if compared to the left and she described a discomfort under the right breast triggered by effort, which would get better at rest and worse if the triggering activity would not stop. She took 125 mg of Atenolol, 100 mg of acetylsalicylic acid and 10 mg of atorvastatin per day.