Aim:
Acute coronary syndrome (ACS) during pregnancy and after delivery remains a challenging problem, often resulting in delayed diagnosis and management. The aim is to provide a diagnostic workup to differentiate coronary artery aneurysm as a final diagnosis.

Material and methods:
This report describes a case of ACS in early post-partum period in female without any predisposing cardiovascular risk factors and no history of any connective tissue disorder or infectious diseases.

Case report:
The patient was presented with chest pain, new ECG changes indicating ischemia, an increase in troponin and NT pro BNP, elevated D-dimer levels, and wall motion abnormalities on an Echo. A chest computed tomography angiography did not show pulmonary embolism but revealed a sac-like aneurysm of the left anterior descending artery (LAD). The coronary angiogram confirmed an aneurysm of the LAD in 6-7 segments, along with an extended 80% stenosis of the a. intermedia. The interventional cardiology team concluded that the patient required coronary artery bypass grafting (CABG) due to extensive vessel damage. She underwent CABG three months after acute coronary syndrome in an experienced center.

Summary:
Coronary artery aneurysm is a rare disorder, which can be presented as a random findings on cardiac imaging or ACS with life-threatening consequences. In patients with ACS due to CAE culprit, the emphasis is to restore flow. Decisions regarding medical, interventional, or surgical treatment should be made on an individual basis. Prospective studies and registries are necessary to improve patient care and outcomes.