Coronary artery vasospasm induced acute myocardial infarction in pregnancy: a new case and systematic review of the literature

Abstract

Background Acute myocardial infarction (AMI) in pregnancy is a rare event and of the causes, coronary artery vasospasm (CAV) is considered even more uncommon. Purpose We present a new case report of a woman at 32 weeks of pregnancy with an AMI from CAV with a normal coronary angiogram. We performed a systematic review of similar cases of spontaneous AMI related to CAV to better understand its characteristics and management. AMI was defined as elevated cardiac enzymes (troponin or CKMB) with chest pain and/or electrocardiogram (EKG) changes consistent with ischemia. Methods We use the terms “acute myocardial infarction”, “myocardial infarction”, “coronary artery vasospasm” and “pregnancy” for our PubMed review. We also evaluated all references in identified manuscripts. Six cases of AMI in pregnancy due to CAV have been reported as of November 2016, including ours. Results and conclusion Six cases of AMI due to CAV during pregnancy or postpartum are reported in the literature, including ours. Patients experiencing this condition tend to be of advanced maternal age, multigravida and in their third trimester or postpartum. Successful management with a combination of long acting nitrates and/or calcium channel blockers achieved symptomatic control in all published cases. Obstetric outcomes were mostly normal, with the majority experiencing uncomplicated deliveries at term.

Inferior STEMI electrocardiogram in a young postpartum female with sickle cell trait with chest pain - a case report

“…5 Coronary artery vasospasm causes a decrease in the blood supply to the myocardium, followed by resultant ischemia and anginal symptoms, with infarction occurring if this spasm persists. 6,7,8 Vascular smooth muscle hyper-reactivity within the coronary arteries is thought to be central to the cause of vasospastic angina. 5,6,7 Vasospasm triggers include cold weather, exercise, exposure to alpha-agonists that promote vasoconstriction (eg, pseudoephredrine), recreational drug use (eg, cocaine, amphetamines), alcohol use, and physical/emotional stress.…”

“…6,7,8 Vascular smooth muscle hyper-reactivity within the coronary arteries is thought to be central to the cause of vasospastic angina. 5,6,7 Vasospasm triggers include cold weather, exercise, exposure to alpha-agonists that promote vasoconstriction (eg, pseudoephredrine), recreational drug use (eg, cocaine, amphetamines), alcohol use, and physical/emotional stress. 8,9 Patients with vasospastic angina tend to present with episodic chest pain lasting 5-15 minutes.…”

Coronary Events in the Pregnant Patient: Who Is at Risk and How Best to Manage?

“…Coronary vasospasm is a rare cause of AMI in pregnancy, with only a few case reports in the literature. 50 It is estimated that vasospasm accounts for around 2% of pregnant patients presenting with AMI or angina. 51 The pathophysiological mechanisms are unclear, but may be related to enhanced vascular reactivity, increased renin release, and endothelial dysfunction in pregnancy.…”