Myocardial infarction in pregnancy: Current topical issues in diagnostics and treatment

Abstract

Lately due to the increase of childbearing age of women, high prevalence of cardiovascular diseases, and, presumably, due to the usage of some medications, there was an increase in myocardial infarction (MI) cases in pregnant women. Risk factors and pathophysiological mechanisms of MI in pregnant women differ from the general population, and are heterogeneous. Pregnancy and childbirth can be defined as ‘physiological stress’ for the cardiovascular system, which can cause MI. Abrupt changes in hemodynamics and increased coagulation state during pregnancy, in childbirth or in the early postpartum period can provoke sudden constriction (vasospasm) of a coronary artery (CA), as well as non-atherosclerotic spontaneous CA dissection, which leads to a critical decrease in the supply of oxygen to the heart muscle. The frequency of hemodynamically significant atherosclerosis of CA is also increasing. The incidence of maternal, perinatal mortality and obstetric complications is higher than in women without history of acute coronary syndrome. Over the past few decades, the diagnosis and treatment of myocardial infarction improved, the number of primary percutaneous coronary interventions in pregnant women increased, and there is now less inpatient mortality. However, due to the absence of large randomized clinical trials on the MI in pregnant women it is impossible to develop a unified algorithm for the management and preventive measures for this condition, thereby it is difficult to select an optimal treatment tactic, and hard to predict subsequent cardiovascular events. In this article we analyzed current data on MI during pregnancy, childbirth, and the postpartum period.