Acute coronary syndrome in pregnant women

Abstract

The purpose of this article is to review the available information on the pathophysiology, diagnosis, treatment and prognosis of acute coronary syndromes (ST-elevation myocardial infarction [STEMI] and non-ST-elevation myocardial infarction [NSTEMI]) during all stages of pregnancy. We searched the English-language literature indexed in MEDLINE, Scopus and EBSCO host research databases from 1980 through to August 2010 using the indexing terms 'pregnancy', 'ante-,peri-, and postpartum', 'acute coronary syndrome', 'myocardial infarction', 'STEMI' and 'NSTEMI'. Symptomatic coronary artery disease is still infrequent in women of childbearing age, but the recent increase in its prevalence in pregnancy has been attributed to the modern trend of childbearing in older years because many young working women are postponing having children. Although rare, acute pregnancy-related MI is a devastating event that may claim the life of a mother and her fetus. The incidence of MI is estimated at 0.6-1 per 10,000 pregnancies. The case fatality rate has been reported to be 5-37%. Owing to the rarity of the event, information related to MI in pregnancy is derived from case reports and, therefore, is subject to considerable reporting bias. Treatment needs to be prompt and urgent because of the very high mortality rate. Current guidelines for the diagnosis and treatment of MI should be expanded to include pregnancy-related MI. Screening and management of cardiovascular risk factors should be achieved before pregnancy.

Takotsubo cardiomyopathy after cesarean: A case report and published work review of pregnancy‐related cases

“…Electrocardiogram abnormalities, ranging from ST changes to T‐wave inversion, were reported in 94% (17/18) of the cases. Furthermore, the serum level of at least one cardiac enzyme was elevated in 92% (12/13) of the cases, which is also similar to ACS . Therefore, P‐TCM does not have pathognomonic symptoms because the primary symptoms are similar to those of other complications.…”

Cardiovascular Disorders in Pregnancy: Diagnosis and Management

“…Peri-partum myocardial infarction is a rare complication. Its pathophysiology, diagnosis, treatment and prognosis is reviewed by El-Deeb and co-workers [28].…”

Acute Coronary Syndrome in Pre- and Post-partum Women – A Review

“…56 Aspirin has been classified to an intermediate-risk (Class C) and its use is safe in the second and third trimester whereas in the first trimester there is incidence of birth defects in animal studies. 55 Clopidogrel appears safer for the foetus, but regional anaesthesia and surgical intervention are contraindicated for high bleeding risk. 57 Few data exist about glycoproteinIIB/IIIA inhibitor treatment in pregnancy, even if tirofiban and eptifibatide (Class B) are considered safer than abiciximab (Class C).…”

“…X-ray exposure during percutaneous treatment may have teratogenic repercussion on the foetus. However, it has been shown that by adopting the above mentioned precaution even time-consuming procedures result in a low exposure, 55 with an overall 1.47 relative risk of developing malignant disease. 48 Considering the different kind of pathogenetic mechanism of ACS in pregnants it is important to consider early how the amount of myocardium is at risk and rule out the aetiology.…”