Ischaemic heart disease and pregnancy

Abstract

Although ischaemic heart disease is currently rarely encountered in pregnancy, occurring between 2.8 and 6.2 per 100 000 deliveries, it is becoming more common as women delay becoming pregnant until later life, when medical comorbidities are more common, and because of the higher prevalence of obesity in the pregnant population. In addition, chronic inflammatory diseases, which are more common in women, may contribute to greater rates of acute myocardial infarction (AMI). Pregnancy itself seems to be a risk factor for AMI, although the exact mechanisms are not clear. AMI in pregnancy should be investigated in the same manner as in the non-pregnant population, not allowing for delays, with investigations being conducted as they would outside of pregnancy. Maternal morbidity following AMI is high as a result of increased rates of heart failure, arrhythmia and cardiogenic shock. Delivery in women with history of AMI should be typically guided by obstetric indications not cardiac ones.

Spontaneous Coronary Artery Dissections: A Systematic Review

“…Notably, treatment for P-SCAD is analogous to that of non-pregnancy-related SCAD, with caution to both maternal and foetal outcomes. Foetal radiation concerns suggested avoiding coronary angiography in stable pregnant women [27] but, due to higher mortality in pregnant women and to the negligible foetal radiation exposure with shielding, the standard of care treatment of AMI should be applied also to pregnant women [45].…”

Spontaneous Coronary Artery Dissection Causing Cardiac Arrest in a Post-Partum Patient – A Case Report

“…9 Although coronary angiography necessitates radiation exposure, pregnant women presenting with high-risk features of ACS or SCAD should still be treated according to the standard of care for acute myocardial infarction. 16 The degree of radiation is low especially with shielding, and risk of potential cardiovascular collapse and death for both mother and fetus is high. 17 Other important considerations for emergency department management include utilizing the left lateral recumbent position to optimize venous return, considering the use of continuous fetal monitoring especially in the viable fetus, and considering the use of antenatal corticosteroids if pre-term delivery is anticipated within days.…”

Zawał serca z uniesieniem odcinka ST u 27-letniej kobiety w ciąży

“…However, it is becoming more and more common nowadays because women decide to become mothers at a later age when they already have comorbidities. [1] Coronary heart disease accounts for > 20% of all maternal deaths due to cardiac causes. As far as the aetiology of the disease is concerned, nonatherosclerotic causes dominate, including pregnancy-related spontaneous coronary artery dissection (43%), cases with normal large coronary arteries observed in coronary angiography (18%) and coronary artery thrombosis (17%) [2].…”

“…Pregnancy-related acute coronary syndrome (ACS)/AMI occurs most frequently in the third trimester [ST-segment elevation myocardial infarction (STEMI) 25%, non-ST-segment elevation myocardial infarction (NSTEMI) 32%] or in the postpartum period (STEMI 45%, NSTEMI 55%). The clinical picture is the same as in the general population [1]. In case of STEMI, percutaneous coronary intervention (PCI) is preferred.…”