Successful primary percutaneous coronary intervention in the first trimester of pregnancy

Babić, Zdravko; Gabrić, Ivo Darko; Pintarić, Hrvoje

doi:10.1002/ccd.22813

Cited by 19 publications

(12 citation statements)

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“…These recommendations should also be applied to pregnant women with the same conditions. However, our data demonstrate Heart failure/cardiogenic shock 56 (38) Ventricular arrhythmias 18 (12) Recurrent angina/MI 29 (19) Maternal mortality 10 (7) Fetal mortality 7 (5) MI indicates myocardial infarction.…”

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confidence: 75%

Pregnancy-Associated Acute Myocardial Infarction

et al. 2014

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1695T he incidence of coronary artery disease (CAD) in women of child-bearing age is low, and acute myocardial infarction (AMI) is uncommon.1,2 Pregnancy, however, has been shown to increase the risk of AMI ≈3-fold compared with the risk in nonpregnant women of similar age. [2][3][4][5] Although previous studies have provided some data related to the incidence of pregnancyassociated MI (PAMI), clinical characteristics, risk factors, and outcome 1,2,4 more information is needed on the mechanisms of AMI, the efficacy and safety of standard therapy, and the applicability of guideline recommendations designed for the general AMI population, to women with PAMI.The aim of this study was therefore to review contemporary data on PAMI in an attempt to provide recommendations for the management of this condition. MethodsA literature search for cases with AMI related to pregnancy was performed using PubMed and Google Scholar. References from these studies were cross-checked to obtain additional studies that may have been missed by the original search.All original articles were obtained online or by interlibrary communication. Articles published in languages other than English were translated by medical translators. A total of 134 cases published in the literature from 2006 to 2011 not included in a previous review 4 were included in this study. In addition, 7 cases presented at the First International Congress on Cardiac Problems in Pregnancy in 2010 (Valencia, Spain) and 9 patients treated or consulted by the authors were also included in the analysis. Recommendations were made on the basis of available clinical information, with the understanding that the cases published in the literature and reviewed by us do not represent all the patients who developed PAMI during the period of the study and that reporting may therefore be incomplete and biased. ResultsOne hundred fifty patients with PAMI were included in the study (Table 1). The age ranged from 17 to 52 years; the mean age was 34±6 years; 75% of the patients were >30 years of age; and 43% were >35 years. Reported risk factors for CAD included smoking in 25% of the patients, dyslipidemia in 20%, hypertension in 15%, and diabetes mellitus and a family history of CAD in 9% each.The type and timing of AMI are shown in Figure 1. Data on the type of AMI were available in 139 of the patients. Of these, 105 (75%) presented with ST-segment-elevation MI (STEMI) and the rest with non-STEMI (NSTEMI). The majority of the patients developed AMI during either the third trimester of pregnancy (STEMI, 25%; NSTEMI, 32%) or the postpartum period (STEMI, 45%; NSTEMI, 55%). The myocardial infarct involved the anterior wall of the left ventricle (LV) in 69% of the patients, the inferior wall in 27%, and the lateral wall in 4%. Table 2 shows the mechanisms of AMI. Coronary angiography was performed in 129 patients and demonstrated coronary dissection (CD) in 56 patients (43%), atherosclerotic disease in 27%, a clot without angiographic evidence for atherosclerotic disease in 22 patients (1...

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confidence: 75%

Pregnancy-Associated Acute Myocardial Infarction

et al. 2014

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“…The safety of ivabradine during pregnancy in humans is unknown; only one case report has been published, showing no adverse effect on the fetus (2). No data are available to specify how much ivabradine crosses the placental barrier.…”

Section: Discussionmentioning

confidence: 99%

Heart rate changes mediate the embryotoxic effect of antiarrhythmic drugs in the chick embryo

Kočková

Svatunkova

Novotný

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

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Kockova R, Svatunkova J, Novotny J, Hejnova L, Ostadal B, Sedmera D. Heart rate changes mediate the embryotoxic effect of antiarrhythmic drugs in the chick embryo. Am J Physiol Heart Circ Physiol 304: H895-H902, 2013. First published January 11, 2013; doi:10.1152/ajpheart.00679.2012.-A significant increase in cardiovascular medication use during pregnancy occurred in recent years. Only limited evidence on safety profiles is available, and little is known about the mechanisms of adverse effect on the fetus. We hypothesized that drug-induced bradycardia is the leading mechanism of developmental toxicity. Embryotoxicity was tested in ovo after administration of various doses of metoprolol, carvedilol, or ivabradine. Embryonic day (ED) 4 and 8 chick embryos were studied by video microscopy and ultrasound biomicroscopy ex ovo after intraamniotic injection of the drug for a period of 30 min. Stroke volume was calculated by the Simpson method and prolate ellipsoid formula. Significant dose-dependent mortality was achieved in embryos injected with carvedilol and ivabradine. In ED4 embryos, metoprolol, carvedilol, and ivabradine reduced the heart rate by 33%, 27%, and 55%, respectively, compared with controls (6%). In ED8 embryos this effect was more pronounced with a heart rate reduction by 71%, 54%, and 53%, respectively (controls, 36%). Cardiac output decreased in all tested groups but only proved significant in the metoprolol group in ED8 embryos. The number of ␤-adrenergic receptors showed a downward tendency during embryonic development. A negative chronotropic effect of metoprolol, carvedilol, and ivabradine was increasingly pronounced with embryonic maturity despite a downward trend in the number of ␤-adrenergic receptors. This effect was associated with reduced cardiac output in chick embryos, probably leading to premature death. Although standard doses of these drugs appear relatively safe, high doses have a potentially adverse effect on the fetus through reduced heart rate.

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“…A maioria dos estudos encontrados na estratégia de busca desta revisão abordou a ocorrência de PCR e a realização de RCP após o parto, o que limitou o número de estudos selecionados para esta revisão. Além disso, a grande maioria dos estudos selecionados foram relatos ou séries de casos, o que limita a retirada de conclusões, uma vez que a amostra de pacientes foi muito pequena [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] .…”

Section: Resultsunclassified

“…Além disso, os ritmos de PCR fibrilação ventricular e atividade elétrica sem pulso [15][16][17]19,27,29,30 foram os mais encontrados, achado que condiz com a população em geral, uma vez que as doenças cardiovasculares são as mais frequentes no mundo e no Brasil e que estas podem evoluir para arritmias malignas como nestes casos 7 .…”

Section: Resultsunclassified

“…Os estudos selecionados para esta revisão evidenciaram o desfecho alta materna e fetal com bom prognóstico neurológico na maioria dos casos 14,[16][17][18][19]21,22,25,26,[28][29][30][31][32] , o que pode estar relacionado a ocorrência de PCR em pessoas previamente hígidas, em ambiente intrahospitalar, com início da RCP precoce e realização precoce da cesárea de emergência.…”

Section: Referênciasunclassified

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Ressuscitação cardiopulmonar na gestação: uma revisão integrativa

et al. 2016

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Artigo de revisão resUMoO objetivo deste estudo foi identificar dados sobre atendimento à parada cardiorrespiratória na gestação. Foi realizada uma revisão integrativa de artigos publicados entre 2010 e 2015, em português, inglês e espanhol com a utilização dos seguintes descritores: "Parada Cardíaca"; "Ressuscitação Cardiopulmonar"; "Gestante" e "Gestação", nas seguintes bases de dados: MEDLINE, LILACS, IBECS e CUMED. A idade gestacional variou de 10 a 41 semanas, as etiologias mais comuns da parada cardiorrespiratória foram embolia pulmonar e trauma, os ritmos foram fibrilação ventricular e atividade elétrica sem pulso e o tempo em parada cardiorrespiratória variou de 15 a 60 minutos. O tratamento foi ressuscitação cardiopulmonar, intubação, administração de epinefrina e cesárea de emergência. Os desfechos mais observados nas mães e recém-nascidos foram alta e bom estado neurológico. Conclui-se que protocolos de atendimento específicos podem respaldar e auxiliar a tomada de decisão da equipe durante a ressuscitação cardiopulmonar, aumentando a sobrevida e diminuindo o dano neurológico nestas pacientes.Palavras-chave: parada cardíaca; ressuscitação cardiopulmonar; gravidez. ABstrACtThe objective of this study was to identify data of compliance in cardiac arrest during pregnancy. An integrative review of articles published between 2010 and 2015 in Portuguese, English and Spanish using the following descriptors: "Cardiac Arrest"; "Cardiopulmonary Resuscitation"; "Pregnant" and "Pregnancy" was perfeormed in the following databases: MEDLINE, LILACS, IBECS and CUMED. The gestational age ranged from 10 to 41 weeks, the most common etiologies of cardiopulmonary arrest were pulmonary embolism and trauma, the rhythms were ventricular fibrillation and pulseless electrical activity and the time in cardiac arrest ranged from 15 to 60 minutes. Treatment was cardiopulmonary resuscitation, intubation, administration of epinephrine and emergency cesarean section. The outcomes observed in more mothers and newborns were hospital discharge and good neurological status. In conclusion, specific care protocols can endorse and assist the team's decision-making during cardiopulmonary resuscitation, increasing survival and decreasing neurological damage in these patients.

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Successful primary percutaneous coronary intervention in the first trimester of pregnancy

Cited by 19 publications

References 8 publications

Pregnancy-Associated Acute Myocardial Infarction

Pregnancy-Associated Acute Myocardial Infarction

Heart rate changes mediate the embryotoxic effect of antiarrhythmic drugs in the chick embryo

Ressuscitação cardiopulmonar na gestação: uma revisão integrativa

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