Acute Coronary Syndrome and Preeclampsia

Abstract

From the existing body of literature regarding this patient population, it is unclear why there is a higher incidence of adverse myocardial events. It may be that coronary ischemia has been missed in patients with preeclampsia. Troponin I is now readily available for detection of myocardial damage and should be used in this patient population only when clinically indicated, such as when chest discomfort or new electrocardiogram changes are observed. Patients with preeclampsia may be at higher risk for coronary events, and troponin I levels could be a valuable tool with which to monitor women who develop related symptoms.

Peripartum acute coronary syndrome in an otherwise healthy patient

“…Myocardial ischemia or ACS is a rare event in pregnancies [1][2][3][4][6][7][8]. However, with the increasing incidence of pregnancies in women of advanced maternal age, the frequency of myocardial ischemic events is likely to increase [3].…”

“…Most patients with ACS complain of dull chest pain/ pressure, often with radiation to the neck or left side of the chest [2,4]. These symptoms are frequently accompanied by nausea, dizziness, or a sense of impending doom.…”

“…The incidence of myocardial ischemia during cesarean section is 1:20,000, with approximately 180 cases published in the indexed literature since 1922 [1][2][3]. Risk factors include advanced maternal age, multiparity, hypercholesterolemia, diabetes, thrombophilia, hypertension, and history of tobacco or crack/cocaine abuse [1,4].…”

“…Risk factors include advanced maternal age, multiparity, hypercholesterolemia, diabetes, thrombophilia, hypertension, and history of tobacco or crack/cocaine abuse [1,4]. Pregnancy-related complications such as preeclampsia, blood transfusion, and infection are also linked to increased risk of acute coronary syndrome (ACS) [1][2][3]. Mortality may be as high as 50% [5].…”

The Journal of Maternal-Fetal and Neonatal Medicine

“…Myocardial ischemia and infarction are rare events during pregnancy. Approximately, 150 cases of myocardial infarction (MI) during pregnancy have been documented in literature, worldwide (predominantly anterior wall) [7].…”