Myocardial Infarction during Pregnancy: A Case Report

Abstract

Myocardial infarction during pregnancy is rare. This report presents a 28-year-old parturient with no risk factors for coronary heart disease, in whom an acute anterior myocardial infarction occurred in the 34th gestational week. A caesarian section was performed at term due to an obstetrical cause and under hemodynamic monitoring without complications. Coronary angiography performed 4 months after delivery revealed the presence of normal coronary arteries and mild regional left ventricular dysfunction.

Peripartum acute coronary syndrome in an otherwise healthy patient

“…Myocardial ischemia or ACS is a rare event in pregnancies [1][2][3][4][6][7][8]. However, with the increasing incidence of pregnancies in women of advanced maternal age, the frequency of myocardial ischemic events is likely to increase [3].…”

“…Since all the aforementioned diagnostic modalities have disputable specificity and sensitivity in pregnant patients, cardiac catheterization remains the gold standard to identify coronary pathology leading to ACS [4,7,9,13]. Surprisingly, even this modality has failed to identify the etiology of abnormal cardiac function in a significant number of cases [6,7].…”

“…Hypercholesterolemia is frequently quoted as a risk factor for ACS in pregnancy [1,3,6,8]. Lipid turnover abnormalities may be coupled with relative resistance to insulin in pregnant subjects [1,4,14].…”

Anesthesia for the parturient with cardiovascular disease

“…41,42 The pathophysiology and clinical manifestations are identical to those in the nonpregnant patient. 43 It should be noted that the hemodynamic demands that pregnancy places on the myocardium represent a stress to the coronary circulation. General management guidelines currently include efforts to reduce the cardiac work load with measures such as bed rest, nitrate therapy for preload reduction, and conduction anesthesia during delivery.…”

“…43 Monitoring should be continued for a minimum of 24 hours into the postpartum period to assess increases in pulmonary capillary wedge pressure as intravascular volume increases following delivery and as anesthesia subsides.…”