Acute myocardial infarction in the obstetric patient

Abstract

Acute myocardial infraction (AMI) in the obstetric patient is a rare event, although the incidence is rising due to advancing maternal age and pre-existing cardiac risk factors and medical co-morbidities. While atherosclerotic disease is the leading cause of AMI, coronary artery dissection is an important consideration in pregnancy and in the postpartum period. The physiological changes of pregnancy as well as pregnancy-specific risk factors can predispose the obstetric patient to AMI. Diagnosis of AMI can be challenging as symptoms may be atypical. Furthermore, diagnostic tests must be interpreted in the context of pregnancy. While the overall management of the obstetric patient with AMI is similar to that outside of pregnancy, drug therapy requires modification as some medications may be contraindicated in pregnancy and breastfeeding. There is limited information about prognosis and risk stratification but it is anticipated that future studies will address this issue.

A Mimic of Myocardial Ischemia in a Woman With Hyperemesis Gravidarum

“…Although the overall incidence rate of acute myocardial infarction is low among individuals of reproductive age, pregnancy has been associated with a 3-to 4-fold increased risk of its occurence. 5 In particular, the incidence of spontaneous coronary artery dissection is significantly higher in the peripartum period 5 and is important to consider in this situation.…”

Acute myocardial infarction as the first manifestation of paraganglioma

“…6 Although the incidence of acute myocardial infarction (AMI) in the obstetric population is low, it is rising due to advancing maternal age and medical comorbidities. 12 Even though atherosclerotic disease is the major cause of AMI in this population, spontaneous coronary artery dissection (SCAD) is also a significant cause of AMI in ante, peri and postpartum periods. 12 The pathogenesis of SCAD during these periods is unclear, with a probable role of physiological and hormonal changes contributing to an increased blood volume and altered anticoagulation mechanisms.…”

“…12 Even though atherosclerotic disease is the major cause of AMI in this population, spontaneous coronary artery dissection (SCAD) is also a significant cause of AMI in ante, peri and postpartum periods. 12 The pathogenesis of SCAD during these periods is unclear, with a probable role of physiological and hormonal changes contributing to an increased blood volume and altered anticoagulation mechanisms. 13 The case presented reports a woman with an unclarified history of migraine, recently exposed to a relevant state of stress (delivery), who was diagnosed with an AMI without coronary disease.…”

Assessment and Prediction of Cardiovascular Contributions to Severe Maternal Morbidity

“… 30 The estimated incidence of pregnancy-associated myocardial infarction (PAMI) is 0.6 to 1.0 per 10,000 pregnancies. 31 PAMI risk increases with increasing maternal age and multigravida pregnancies. 30 – 32 A study of 165 cases of PAMI in pregnant women included 68 (54%) that had undergone coronary angiography.…”