Myocardial infarction and pregnancy

Abstract

Key content Myocardial infarction is a rare but life‐threatening medical condition during pregnancy. If unrecognised and not managed appropriately, the associated mortality and morbidity are high. A high index of suspicion, early diagnosis and treatment are essential. Multidisciplinary management involving the obstetric physician, cardiologist, anaesthetists and obstetrician is key to improving outcomes. Learning objectives To revise the physiological cardiovascular changes in pregnancy. To recognise the pathophysiology of myocardial infarction during pregnancy. Identify risks factors for myocardial infarction. Recognise symptoms and signs of myocardial infarction. To learn the general management principles of myocardial infarction in pregnancy. Ethical issues Should asymptomatic pregnant women with multiple risk factors be screened for coronary heart disease?

Diagnostic Angiograms and Percutaneous Coronary Interventions in Pregnancy

“…18 Diagnostic criteria are the same as for patients who are not pregnant and are based on clinical symptoms, ECG changes and an increase in troponin levels. 19,20 It should be noted that ST elevation is not seen in normal pregnancy and warrants urgent attention. 19 STEMI in pregnant women should be managed in the same way as in nonpregnant women.…”

“…In pregnancy, SCAD is the most common cause of AMI and tends to occur mainly in late pregnancy or during the early postpartum period. 7,18,20 Although previously considered rare, it has recently become clear that SCAD is an important and underdiagnosed cause of AMI in women. 26,27 P-SCAD makes up <10% of the total number of SCAD cases.…”

Cardiac conditions in pregnancy and the role of midwives: A discussion paper

“…Often, their clinical presentation will be atypical of ischaemia, with dyspnoea, vomiting or dizziness present (Cantwell et al, 2011). Although AMI in pregnancy was once considered a rare occurrence, recent statistics indicate increased incidence, with a maternal death rate ranging between 20%-37% (Knight et al, 2016;Merrigan, 2009;Wuntakal et al, 2013). With a growing number of women delaying childbirth to later reproductive years, ischaemic cardiac disease is expected to become more prevalent (Roth & Elkayam, 2008;Turitz & Friedman, 2014).…”

Acute Myocardial Infarction during Pregnancy

“…• Associated cardiovascular comorbidities: AMI women had more cardiovascular comorbidities such as hypertension, diabetes, thrombophilia, tobacco use, dyslipidemia, known heart failure, anemia, renal insufficiency malignancy, strong family history of migraine headaches, and cocaine usage. 6 With increasing maternal age and increasing coronary artery disease (CAD) in young patients, the number of preexisting CAD patients becoming pregnant is also increasing. Pregnancy may be considered in patients with known CAD in the absence of residual ischemia and clinical signs of left ventricular (LV) dysfunction.…”

“…These conditions are to be ruled out before going for specific management of ACS in pregnant women. • Electrocardiogram: Even though new ST depressions, T-wave inversions (in inferior and lateral leads, small Q wave and inverted T wave in lead III, Q wave in lead aVF, inverted T waves in V1, V2, and occasionally V3), and left-axis deviation (15-20 degrees) may be normally seen in pregnancy, 6,10 ST elevations are never seen in normal pregnancy. Therefore, new ST elevation in two consecutive leads suggests AMI in the pregnant woman.…”