Myocardial infarction and subsequent pregnancy

Abstract

We report the case of a 40-year-old The prevalence of coronary heart disease in women of childbearing age is low when compared with that in men of the same age group. This difference, however, decreases as age increases. Coronary heart disease accounts for 5% of the deaths in women from 35 to 44 years of age in developed countries, such as the United States of America and the United Kingdom 1 . It is estimated that coronary heart disease may complicate 1/10,000 pregnancies and may be potentially lethal for both the mother and the fetus 2,3 . In a series of published cases during the period from 1943 to 1997, 33 pregnancies in women with previous infarction were reported, out of which, 16 were properly investigated 2 . The risks associated with subsequent pregnancies depend on such factors as the status of the coronary anatomy, the presence of myocardial ischemia, and the residual left ventricular function 4 . As reports in the literature about maternal and fetal management and outcome are limited, cardiologists and obstetricians feel insecure about handling these patients.Hypertensive disorder of pregnancy is known to complicate 10% of gestations, causing an increase in maternal and perinatal morbidity and mortality. The incidence of that disorder is increased in patients with previous predisposing factors, such as nulliparity, multifetal gestation, hypertension, and diabetes, previous or familial history of preeclampsia, fetal hydrops, hydatidiform mole 5 . Maternal complications associated with the hypertensive disorder of pregnancy include the following: premature detachment of the placenta, pulmonary edema, respiratory distress, disseminated intravascular coagulation, cerebral hemorrhage, hepatic failure, renal failure . The risk is higher in older women, those with preexisting vascular disease (arterial hypertension, renal disease, type I diabetes mellitus), in multifetal gestations, and in those women with complications in previous pregnancies 6 . Genetic forms of thrombophilia (tendency to the occurrence of thrombosis) are related to adverse gestational results. However, the value of a routine investigation in such cases is questionable 6 . Case ReportA 40-year-old pregnant white female, gravida III (GIII) para II (PII), last delivery 18 years before, with an echographic gestational age of 23 weeks, sought medical care at the high-risk pregnancy unit of the Hospital Nossa Senhora da Conceição. She reported an inferior myocardial infarction at the age of 31 years and an anteroseptal myocardial infarction at the age of 38 years. After the latter event, coronary angiography showed a proximal segmentary lesion occupying 95% of the lumen of the anterior descending artery, a segmentary lesion of 50% in the right coronary artery, and a segmentary lesion of 50% in the medium third of the posterior ventricular branch of the right coronary artery. Ventriculography showed inferior akinesia and anteroapical hypokinesia (figs. 1 to 4). Based on these findings, the patient underwent myocardial revascularization with ...

Pregnancy with prior coronary artery disease: Specific concerns

“…Presence of myocardial ischaemia, status of the coronary artery anatomy and residual ventricular function influence the risks associated with subsequent pregnancies. 2 A team involving cardiac and obstetric specialists for evaluation and monitoring of such cases are mandatory in pregnancies post MI. 3 We report successful outcome of a 35 year old pregnant female patient with history of myocardial infarction treated with angioplasty and stent to left anterior descending artery (LAD).…”

"Successful Pregnancy Outcome After Myocardial Infarction with PCI, a Case Report"

“…Using clopidogrel in pregnancy is controversial due to pregnancy category C. Therefore usually clopidogrel is discontinued and replaced with antiplatelet therapy. However many factors influence the course of coronary heart disease in pregnancy: left ventricular systolic function, the condition of coronary arteries, time elapsed from myocardial infarction [3,4].…”