Neonatal myocardial infarction due to thrombotic occlusion

Neonatal myocardial infarction is rare and its prognosis is poor. We describe the clinical course and autopsy findings of a newborn female with myocardial infarction. Her clinical course was rapidly progressive, becoming fatal before we could detect the cause. Autopsy demonstrated significant occlusion of the left coronary artery as well as evidence of new infarction, suggesting that the event occurred at birth. This case illustrates myocardial infarction as a possible cause of early neonatal death.     

Low-dose oral contraceptive-induced acute myocardial infarction

Objectives: Since their introduction, oral contraceptives (OCs) have been associated with risk to both the venous and the arterial systems. Studies have shown that OC use is associated with a risk of venous thromboembolism, ischaemic stroke and acute myocardial infarction (MI). MI is rarely seen in patients using OCs, particularly in the absence of clinical risk factors or smoking.

Case: We report a case of acute inferior MI in a 20-year-old non-smoker who had used a low-dose OC (3?mg drospirenone and 30?μg ethinyl estradiol) for 1 month. As far as we know, this is the youngest case of acute MI associated with a low-dose OC.

Conclusion: Low-dose OCs may also be responsible for acute MI even in a very young female without any cardiovascular risk factors. Therefore, the clinicians should be aware of this mortal events during follow-up of the patient using OCs.     

Pregnancy after myocardial infarction and a coronary artery bypass graft

The authors report a pregnancy in a 34 year old patient who previously experienced a myocardial infarction. The pregnancy ended at 39 weeks in the birth of a healthy girl weigthing 3040 g, by cesarean section under epidural anesthesia. A review of the literature revealed 33 similar cases, 16 of which were adequately documented. Received: 23 January 1997 / Accepted: 20 March 1997     

急性心梗患者行静脉溶栓治疗的临床护理分析

探讨整体护理干预对急性心肌梗死患者静脉溶栓治疗效果的影响。方法:选择90例急性心肌梗死患者,采用静脉溶栓治疗方法,随机分为两组,护理干预组采用整体护理方法,对照组采用常规护理方法,比较两组患者静脉溶栓治疗过程中并发症情况、溶栓过程中出现恐惧、焦虑等症状情况、出院满意度。结果:护理干预组45例,出现静脉溶栓并发症的5例,占9.26%,对照组45例,出现静脉溶栓并发症的9例,占20.00%,两组比较P>0.05,差异无统计学意义;护理干预组溶栓过程中出现恐惧、焦虑的6例,占17.78%,对照组出现恐惧、焦虑的16例,占35.56%,两组比较,P<0.05,差异有统计学意义;护理干预组满意39例,出院满意度86.67%,对照组满意32例,占71.11%,两组比较,P<0.05,差异有统计学意义。结论:采用护理干预,能有效地减轻了患者静脉溶栓治疗过程中恐惧和焦虑的心理状态,提高患者对静脉溶栓治疗的满意度。     

Myocardial infarction as a complication of pheochromocytoma in a pregnant woman

Pheochromocytoma is an unusual cause of hypertension during pregnancy. We present a 40-year-old woman who had a myocardial infarction during pregnancy in whom pheochromocytoma was subsequently diagnosed. This disorder carries a high risk of maternal and perinatal mortality, if undiagnosed prior to delivery. Therefore, the diagnosis of pheochromocytoma should be considered in pregnant patients who exhibit a marked fluctuation in hypertension. Urinary concentrations of catecholamines and their metabolites should be measured in such cases.     

Acute myocardial infarction in early pregnancy: definition of myocardium at risk with noncontrast T2-weighted cardiac magnetic resonance

We report a case of a 34-year-old woman who had a left anterior wall myocardial infarction develop in the first trimester of pregnancy. Despite urgent and successful revascularization, she demonstrated persistent segmental wall motion abnormalities by transthoracic echocardiography. To manage this patient safely through pregnancy with a better definition of myocardium at risk, a cardiac magnetic resonance examination was performed. This identified a large territory of acutely edematous myocardium in addition to providing accurate volumetric measurements of left ventricular size and function. Because of her gravid state, gadolinium was not administered nor was it required to delineate the region of myocardium at risk.     

Menstrual and reproductive factors and risk of non-fatal acute myocardial infarction in Italy

OBJECTIVE: We analyzed the relation between factors related to endogenous female hormones and the risk of acute myocardial infarction (AMI). STUDY DESIGN: We used a combined dataset from three Italian case-control studies, including 609 women with non-fatal AMI and 1106 controls hospitalized for acute conditions. RESULTS: The odds ratios (OR) of AMI were 1.36 (95% confidence intervals, CI 0.95-1.96) in women with an irregular menstrual pattern compared to a regular one, and 1.45 (95% CI 1.07-1.97) in parae compared to nulliparae, without linear trend in risk with number of children. No relation was found with menopausal status, age at menarche and menopause, abortion, and age at first and last birth. Compared to women without abortions the OR was 0.84 (95% CI 0.60-1.18) for >1 abortion; compared to women without spontaneous or induced abortion, the ORs were 0.92 (95% CI 0.62-1.38) for >1 spontaneous and 0.63 (95% CI 0.36-1.08) for >1 induced abortion. The association of parity and irregular menstrual cycles was stronger in pre-/peri-menopausal women and in current smokers. Compared to nonsmokers with regular menstrual cycle, the OR was 5.98 (95% CI 3.38-10.56) for smokers with irregular one, and compared to nonsmokers nulliparae the OR for smokers parae was 4.77 (95% CI 3.12-7.29). CONCLUSIONS: Irregular menstrual cycles and parity were related to increased AMI risk, mainly among pre-/peri-menopausal women and among smokers.     

Unilateral nonhaemorrhagic adrenal infarction as a cause of abdominal pain during pregnancy

Abstract

Adrenal infarction is usually associated with bilateral adrenal hemorrhage in the setting of antiphospholipid syndrome or hemodynamic variation. Few cases of unilateral nonhemorrhagic adrenal infarction (NHAI) have been described in the literature. Here, we report a case occurring during pregnancy. A 30-year-old woman presented at 32?weeks of gestation with sudden-onset right abdominal pain and contractions. Unilateral adrenal infarction was diagnosed following computed tomography (CT). It showed an enlarged right adrenal, without hyperenhancement. Because of persisting contractions, despite medical care, she delivered a healthy, albeit premature, girl. Abdominal pain decreased right after delivery. Three month later, CT imaging showed atrophy of the right adrenal and a normal left adrenal. The patient’s adrenal hormonal function was normal. Accurate diagnosis of NHAI remains difficult as its clinical presentation is not specific. It can only be performed with adrenal imaging. Magnetic resonance imaging shows diffuse enlargement of one or both adrenals and an edema on T2-weighted images. Anticoagulation therapy may be discussed. Patients should be evaluated between 3 and 6?months after the event to assess adrenal size and function. In summary, NHAI during pregnancy is probably underdiagnosed and obstetricians should be aware of this or diagnostic difficulty.     

Breast Cancer in Pregnant and Postpartum Women

Breast cancer is reported to occur in from I in 3000 to I in 10 000 pregnancies worldwide. In the United States, 10% to 20% of breast cancers occur in women of childbearing age. Diagnosis and treatment of breast cancer during pregnancy present many additional challenges.     

Postpartum aortic dissection

Postpartum aortic dissection is a rare but lethal event. Until now, only a limited number of cases have been reported, and a comprehensive literature review from 1988 to 2012 yielded 27 cases. Postpartum aortic dissection occurred between Day 1 and Day 42 after delivery, either vaginally or by cesarean section. Pregnancy alone without underlying contributing risk factors and Marfan syndrome were the two main risk factors for postpartum aortic dissection, accounting for 44.4% and 40.7% of cases, respectively. Late presentation and delayed diagnosis may lead to sudden death. Improving prenatal and peripartum care is, therefore, crucial in preventing the development of aortic dissection. Prompt diagnosis and timely treatment of postpartum aortic dissection may prevent patient death.     

Postpartum depression and social support in adolescents

OBJECTIVE: The purpose of the study was to determine the effectiveness of a social support intervention delivered to pregnant adolescent girls between 32 and 36 weeks of gestation in preventing symptoms of depression at 6 weeks postpartum. DESIGN: The study used a repeated measures design. SETTING: Data were collected at a teenage parenting program, an educational option of the public school system. PARTICIPANTS: Participants (n = 128) were pregnant and postpartum adolescents. MAIN OUTCOME MEASURE: Symptoms of depression at 6 weeks postpartum. INTERVENTION: Participants completed the Postpartum Support Questionnaire, Rosenberg's Self-Esteem instrument, and the Center for Epidemiological Studies of Depression instrument at baseline, then were randomly assigned to one of three intervention groups (pamphlet, video, or pamphlet plus video) or the control group. The content of the intervention was based on a synthesis of the literature describing social support needed and desired by postpartum adolescents. RESULTS: No significant differences were found in Center for Epidemiological Studies of Depression instrument scores among the groups at 6 weeks postpartum. Using path analysis, the authors found that predictors of symptoms of depression at 6 weeks postpartum were (a) receiving more support from friends, family, and others and (b) having low self-esteem. CONCLUSION: These findings differ from earlier studies, and both research and clinical implications are discussed.     

Takotsubo cardiomyopathy--transient left ventricular apical ballooning mimicking acute myocardial infarction.

Takotsubo cardiomyopathy is characterized by transient left ventricular dysfunction with clinical symptoms of chest pain, electrocardiographic changes of ST-segment elevation or T wave inversion, which mimics acute myocardial infarction in patients without angiographically significant coronary artery stenosis. We report a 75-year-old woman with a history of chest tightness who presented with typical pictures of takotsubo cardiomyopathy. Acute myocardial infarction was initially diagnosed based on the electrocardiographic changes and elevated troponin. Apical akinesis and ballooning with basal hyperkinesis were noted during left ventriculography. Coronary angiography, however, did not show significant coronary artery stenosis. Electrocardiography was normal 3 months later. Follow-up echocardiography did not show any wall motion abnormality. This patient remained well without chest pain or dyspnea over 24 months of follow-up. Optimal medical management of takotsubo cardiomyopathy remains unclear. This patient received diltiazem to prevent possible coronary artery spasm. The prognosis of this syndrome seems to be favorable except for occasional mortality due to left ventricular rupture or ventricular arrhythmia. Recurrence of this syndrome is rare.