Early diagnosis of postpartum acute myocardial infarction with combined use of troponin T and heart‐type fatty acid‐binding protein rapid assay

Abstract

Acute myocardial infarction (AMI) during pregnancy or in the early postpartum period is a rare event but may cause perinatal morbidity and mortality. Early diagnosis of AMI is critical for appropriate treatment. We report a case of postpartum AMI in a 40-year-old multiparous woman with varicose veins. On postpartum day 3, the patient suffered severe chest pain. She had been administered oral methylergometrine. In addition to ST-segment elevation in her electrocardiogram, the patient presented with a positive result on whole blood rapid panel tests for troponin T and heart-type fatty acid-binding protein (H-FABP). These findings indicated AMI in the anterolateral wall. The chest pain disappeared with the prompt administration of intravenous pentazocine hydrochloride and sublingual nitroglycerin spray. Angiography did not reveal any signs of coronary stenosis. To our knowledge, this is the first report of postpartum AMI diagnosed rapidly with combined use of troponin T and H-FABP qualitative panel tests.

Pregnancy-Related Acute Myocardial Infarction: A Review of Epidemiology, Diagnosis, Medical And Surgical Management

“…Also some of cardiac signs can be found in normal pregnant patients such as elevated jugular vein pressure, apical point displacement, parasternal lift, increase S1 or S2 heart sounds and even extra heart sounds such as S3 or systolic ejection murmur (17). During normal pregnancy creatine kinase (CK) concentration can increase and then specificity of CK-MB is lower (29,30). Cardiac specific troponin I (cTnI) is more specific than CK-MB, because cTnI level does not increase above normal limit during uncomplicated pregnancy, delivery, or surgical cesarean section (CS) but can be elevated in gestational hypertension or preeclampsia (29)(30)(31).…”

“…During normal pregnancy creatine kinase (CK) concentration can increase and then specificity of CK-MB is lower (29,30). Cardiac specific troponin I (cTnI) is more specific than CK-MB, because cTnI level does not increase above normal limit during uncomplicated pregnancy, delivery, or surgical cesarean section (CS) but can be elevated in gestational hypertension or preeclampsia (29)(30)(31). ECG changes in pregnancy associated AMI is the same as nonpregnant patients, but some pregnancy-related changes can be seen in normal uncomplicated women such as left axis deviation due to diaphragmatic elevation by fetus or Q wave and T inversion in lead III (8,17,32).…”