Myocardial infarction in the 34th week of gestation: case report

Acute myocardial infarction during pregnancy is a rare event that is often associated with a very high maternal mortality, estimated to be from 19 to 37%. During the last decades the incidence of myocardial infarction during pregnancy has increased . The main contributing factor could be a higher prevalence of the metabolic syndrome. The strongest predictors correlated with a myocardial infarction are hypertension, diabetes mellitus and advanced maternal age. In addition, improved diagnostic tools could explain the elevated incidence of myocardial infarction during pregnancy. In general gestation is not considered a risk factor for myocardial infarction but gravidity is accompanied by an increase in oestrogen and progesterone levels. It is generally accepted that oral contraceptives increase the risk of coronary heart disease. We present a case where a 37-year-old gravida was admitted to hospital with diffuse thoracic pain. In the patient's history, we found several putative reasons for the thoracic pain that pointed to a musculoskeletal cause. Based on an elevation of ischaemic heart markers and continuous non-specific thoracic pain we performed a primary Cesarean section. In the coronary angiography procedure that followed, a thrombotic occlusion of the ramus diagonalis was diagnosed. We here describe the differential diagnosis as well as the problems associated with diagnosing myocardial infarction in the third trimester of pregnancy.     

Treatment of acute myocardial infarction in pregnancy with coronary artery balloon angioplasty and stenting

Acute myocardial infarction in pregnancy is a rare condition with substantial risk of maternal and fetal mortality. We present a case of myocardial infarction during pregnancy which was treated by percutaneous coronary artery balloon angioplasty and stenting with excellent pregnancy outcome.     

Pregnancy after myocardial infarction: are we playing safe?

The safety of pregnancy after myocardial infarction remains a significant dilemma for both the obstetrician and the cardiologist. Only 20 cases of pregnancy after myocardial infarction have been reported. To clarify this problem, we add our experience of four such cases in which conception occurred 9 months to 9 years after myocardial infarction with no previous consultation. Each woman had an uneventful pregnancy with no cardiac or obstetric complications related to the myocardial infarction. All patients were under the strict supervision of an obstetrician and a cardiologist during pregnancy in our conjoined antepartum-cardiologic clinic. The mode of delivery in all patients was related to the obstetric indications. Our experience and the accumulated experience in the literature demonstrate good prognosis for patients who conceive after myocardial infarction.     

Myocardial infarction during pregnancy: a review

In the present review the world literature on pregnancy complicated by myocardial infarction is summarized, and two additional cases are presented. It is apparent that the majority of pregnant women who have died after myocardial infarction did so at the time of initial infarction, and maternal mortality was greatest if the infarction was late in pregnancy. Moreover, delivery within two weeks of infarction was associated with increased mortality as was reinfarction during labor. These results suggest that the increasing cardiovascular stresses of late pregnancy, especially when intensified by parturition, seriously compromise women with ischemic heart disease. Efforts should therefore be made to limit myocardial oxygen demand/consumption throughout pregnancy, and particularly during parturition. Although principles of management can be generalized, these high risk patients require individualization of care by a multidisciplinary team of cardiologists, anesthesiologists, and obstetricians.     

Infarto agudo de miocardio y gestación

Acute myocardial infarction is rare in women of reproductive age and consequently is uncommon during pregnancy. However, when this event does occur, the risk of maternal-fetal mortality is greatly increased, since, in addition to the risk posed by the myocardial infarction, pregnancy hinders diagnosis and treatment.     

Myocardial Infarction in Pregnancy

Myocardial infarction is a rare complication during pregnancy, with an estimated incidence of one in 10,000 pregnancies. Less than 100 cases have been reported. Pregnancy is associated with profound alterations in the maternal cardiovascular system, making pregnancy in the presence of maternal cardiac disease hazardous. Labour and delivery increase cardiovascular stress. Maternal mortality in pregnancies complicated by myocardial infarction is 35 percent. Delivery within two weeks of infarction, or reinfarction during pregnancy is associated with mortality as high as 50 percent. Perinatal mortality is related to maternal outcome.Clinical management of the pregnant woman with myocardial infarction should be multidisciplinary, involving input from obstetrics, cardiology, and anaesthesia. The goals of management are to decrease cardiac work, prevent extension of infarction, increase oxygenation, and prevent complications. During labour and delivery, adequate analgesia, preferably epidural, is essential. The mode of delivery is controversial, however most authors recommend that Caesarean section be reserved for obstetric indications, with assisted vaginal delivery to shorten the second stage of labour being the preferred method. Cardiac arrest in pregnancy is a rare event, but one for which physicians should be prepared. Perimortem Caesarean section to save the fetus should be considered if maternal resuscitation is unsuccessful. Early recognition of myocardial infarction will facilitate effective management, prevention of complications, and improvement in maternal and perinatal survival.     

Acute myocardial infarction during the second trimester of pregnancy

Acute myocardial infarction during pregnancy is a very rare event. It occurs from 1 per 10,000 to 1 per 30,000 deliveries. Diagnosis of myocardial ischaemia is difficult because of typical complaints in pregnancy such as breathlessness and pain in chest. Its first recognisable symptom is very often loss of consciousness and cardiac death. We present the case of a 36-year-old woman with cardiac arrest in the second trimester of pregnancy. The defibrillation was applied four times with power ranging from 150 J to 200 J. Acute myocardial infarction was diagnosed on the basis of biochemical and electrocardiological examinations. Pharmacological treatment consisted of adrenalin, lidocaine, dopamine, heparin, insulin and cordarone. Uncomplicated pregnancy and delivery by caesarean section is described. A review of literature follows. CONCLUSION: Although myocardial infarction is a rare complication of pregnancy, it always should be taken in consideration, especially in case of multipara older than 32, suffered from hypercholesterolemia or diabetes, treated with beta-mimetics or ergot alkaloid.     

Pregnancy in a woman with a prior myocardial infarction: a case report]

Myocardial infarction during pregnancy is a rare event but is considered to be associated with very high mortality of both mother and fetus. We report uncomplicated cesarean section in the 3rd pregnancy in woman with a prior myocardial infarction that occurred during the first hours after cesarean section delivery of the 2nd pregnancy. Intensive cardiological and obstetrical supervision are required for correct management of the pregnancy.     

Coronary artery disease in diabetic pregnancies

Severe vascular complications of diabetes mellitus include myocardial infarction and when this occurs during pregnancy it is associated with a high risk of maternal mortality. In the absence of myocardial infarction, information is unavailable on pregnancy outcome in diabetic patients with severe coronary artery disease or with prior coronary artery bypass graft. Such a case is presented together with a review of the literature.     

Pregnancy-associated spontaneous coronary artery dissection

Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction that occurs particularly in women during the pregnancy and in the postpartum period. We describe a dramatic case of pregnancy-related spontaneous left main coronary artery dissection that resulted in acute myocardial infarction with severe left ventricular dysfunction and was complicated by acute heart failure and cardiogenic shock. Urgent revascularization and restoration of myocardial perfusion that were performed in this case resulted in marked left ventricular function recovery and clinical improvement.     

Myocardial infarction in early pregnancy

Acute myocardial infarction (AMI) during pregnancy is usually transmural and occurs in late pregnancy with a peak incidence during the peripartum or postpartum periods. We report a pregnancy-related AMI, which occurring as early as the first trimester, was treated conservatively with antithrombotic and anti-ischemic drugs both acutely and through the rest of the ultimately successful pregnancy.     

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.     

妊娠期高血压危象的早期识别及应急救治策略

妊娠期高血压危象会导致孕产妇和胎婴儿严重并发症,如脑血管意外、肺水肿、心肌梗死、急性肾功能衰竭、子宫-胎盘血液灌流不足、胎盘早剥等,是围产期母婴发病及死亡的主要原因。早期识别、严密监测、及时诊断和处理可有效降低严重并发症发生,改善母婴预后。     

Troponin I in the diagnosis of acute myocardial infarction in pregnancy,labor, and post partum

Cardiac troponin I has become the marker of choice for the diagnosis of acute myocardial infarction. There are specific characteristics of this test that makes it desirable for the diagnosis of acute myocardial infarction in pregnancy, labor, and post partum.     

Acute myocardial infarction associated with prostaglandin E2

Prostaglandin E2 is rarely associated with serious maternal side effects when used for second-trimester pregnancy termination. Acute myocardial infarction complicating therapeutic pregnancy termination with prostaglandin E2 in a patient with chronic glomerulosclerosis and severe hypertension is reported.     

Abortion following recent myocardial infarct

There is reported about a 42 years old woman suffering from a myocardial infarction in the 9th weeks of pregnancy. According to her wish the pregnancy was interrupted in the 22nd gestational week by hysterotomy and sterilization of tube. Probable causes, frequency and prognosis are discussed. References are made to the therapeutical action.     

Anwendungsbeschränkung von Aspirin während der Schwangerschaft

The case of a high-risk pregnant woman is reported (morbid obesity, gestation-related hypertension, and diabetes mellitus) who died of hemorrhagic shock a few hours after giving birth by Cesarian section followed by intra-abdominal bleeding and emergency hysterectomy. The patient had been taking acetylsalicylic acid (aspirin, 100 mg per day) until the day before delivery due to her history of a brainstem infarction. Indications for low-dose, administration of aspirin during pregnancy include (1) secondary prophylaxis for myocardial or cerebral infarction, (2) prevention of placental insufficiency with intrauterine growth restriction, (3) prevention of pre-eclampsia, and (4) treatment of antiphospholipid syndrome. Aspirin inhibits platelet thromboxane A2 formation, even at very low doses (e.g. 40–60 mg per day). Since this pharmacological effect persists for the lifespan of the entire circulating platelet population (7–10 days), even after a single dose the drug must be discontinued at least 5 days prior to any scheduled operation. During pregnancy, aspirin (including low-dose administration) must be stopped in all cases after the 37th week of gestation and, if possible, should not be administered during the last 3 months of gestation. For individual patients, an alternative antithrombotic treatment with a low-molecular-weight heparin may be considered.     

Myocardial infarction in pregnancy associated with clomiphene citrate for ovulation induction: a case report

BACKGROUND: Clomiphene citrate (CC) is commonly prescribed for ovulation induction. It is considered safe, with minimal side effects. Thromboembolism is a rare but life-threatening complication that has been reported after ovulation induction with CC. Spontaneous coronary thrombosis or thromboembolism with subsequent clot lysis has been suggested as one of the most common causes of myocardial infarction (MI) during pregnancy, with a subsequently normal coronary angiogram. CASE: A 33-year-old woman with a 5-week gestation had recently received CC for ovulation induction and presented with chest pain. An electrocardiogram showed a lateral and anterior wall myocardial infarction. Cardiac enzymes showed a peak rise in troponin I to 9.10 ng/mL. An initial exercise stress test was normal. At the time of admission, the patient was at high risk of radiation injury to the fetus, so a coronary angiogram was postponed until the second trimester. It showed normal coronary vessels. CONCLUSION: This appears to be the first reported case documenting a possible association between CC and myocardial infarction. Thrombosis might be a rare but hazardous complication of CC. Given this life-threatening complication, appropriate prophylactic measures should be used in high-risk woman undergoing ovarian stimulation.     

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     

Case report: successful pregnancy and delivery after myocardial infarction and essential thrombocythemia treated with clopidrogel

We describe a case of a woman with essential thrombocythemia (ET) who had a subsequent successful pregnancy after a myocardial infarction and aortocoronary bypass grafting. We report the therapeutic management with clopidogrel and low molecular weight heparin. A healthy child was born spontaneously after 41 weeks of pregnancy. The placenta was morphologically normal. No maternal cardiac problems occurred.