A myocardial infarction during pregnancy treated by percutaneous transluminal coronary angioplasty and stent implantation. Case report

Acute myocardial infarction is an un-frequent event during pregnancy. It clearly causes an increase in both maternal and fetal mortality. We describe a case of pregnancy complicated during the second trimester by an acute myocardial infarction witch was treated by percutaneous transluminal coronary angioplasty combined with stenting. The challenge involved in managing this condition during pregnancy is briefly discussed.     

Ergonovine-induced coronary artery spasm and myocardial infarction after normal delivery

Reported is the first known case of postpartum myocardial infarction probably induced by ergonovine maleate, a drug known to provoke coronary artery spasm in susceptible patients.     

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     

Pregnancy in a patient with a history of myocardial infarction and coronary artery bypass grafting

A 37-year-old woman conceived after experiencing a myocardial infarction and undergoing three-vessel aortocoronary artery bypass grafting. Pregnancy was complicated by angina, which was successfully treated with propranolol and bed rest. At term the patient underwent vaginal delivery, without evidence of intrapartum myocardial ischemia or failure.     

Outcome of primary percutaneous coronary intervention in octogenarians with acute myocardial infarction.

BACKGROUND/PURPOSE: Acute myocardial infarction (AMI) results in more complications and increased mortality in octogenarians compared to patients in younger age groups. This study investigated the short- and long-term outcomes in octogenarians after primary percutaneous coronary intervention (PCI). METHODS: During the study period from May 1997 to August 2004, 54 patients > or = 80 years old with ST-elevation myocardial infarction (STEMI) were eligible for primary PCI. Data collected included baseline clinical characteristics and usage of cardiovascular medications. Diagnostic coronary angiography and revascularization procedures were performed using standard practices. During hospitalization, the clinical course including serial changes in cardiac enzymes, adverse events associated with myocardial infarction or treatment, and inhospital or long-term mortality of patients were recorded. RESULTS: The mean age of the 54 patients (35 men, 19 women) was 82.8 +/- 2.5 years (range, 80-89 years). Among them, 27 (50%) had anterior infarction, six (11%) had anterolateral infarction, and 21 (39%) had inferior infarction, inclusive of three patients with accompanying right ventricular infarction. Among them, 20 (37%) patients were in Killip class I, nine (17%) were in class II, two (4%) in class III, and 23 (43%) in class IV. The mean delay from onset of symptoms to arrival in hospital was 220 +/- 167 minutes, and 189 +/- 169 minutes from hospital arrival to reperfusion. Diagnostic coronary angiography revealed that 48 (89%) patients had multivessel disease. Inhospital death occurred in 23 (43%) patients, with the leading causes of death being profound cardiogenic shock (61%), and free wall rupture (26%). CONCLUSION: Octogenarian patients who developed STEMI tended to have multivessel disease. These patients had a high inhospital mortality rate that was most likely to be due to cardiogenic shock.     

Determinants of successful surgical revascularization for failed angioplasty in patients with acute myocardial infarction and cardiogenic shock.

BACKGROUND AND PURPOSE: Previous studies have reported encouraging results with percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI) and cardiogenic shock (CS). However, PTCA fails in many patients and the mortality rate associated with the procedure is very high. This study sought to assess the determinants of successful coronary artery bypass grafting (CABG) in patients with AMI, CS and failed PTCA. MATERIALS AND METHODS: From April 1997 to May 2001, 33 patients with a mean age of 62.9 +/- 10.5 years underwent CABG for AMI, CS and failed PTCA. PTCA failed or was not attempted because of primary failure in 13 patients, reocclusion in three, no-reflow in one, and multivessel disease in 18. Patients were initially stabilized with inotropic infusion and mechanical circulatory support. Before June 2000, patients underwent conventional CABG, while after June 2000, patients underwent beating heart CABG. Risk factor analysis was performed using retrospective chart review. RESULTS: The overall in-hospital mortality rate was 30.3%-33.3% in 24 patients who underwent conventional CABG and 22.2% in nine patients who underwent beating heart CABG. Risk factors for death were unstable hemodynamics (p < 0.001), non-right coronary artery as the infarct-related artery (IRA) (p = 0.012), high inotropic dose (p = 0.013), intubation (p = 0.021), cardiopulmonary resuscitation (p = 0.021), and early bypass (p = 0.050). CONCLUSIONS: CABG was associated with a high in-hospital mortality rate in patients with AMI, CS and failed PTCA. Patients with unstable hemodynamics and high inotropic dose before surgery had the worst survival rate.     

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.     

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。     

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.     

Acute myocardial infarction in pregnancy and the puerperium: a population-based study

OBJECTIVE: To estimate the population-based incidence and pregnancy outcomes of acute myocardial infarction (MI) in pregnancy. METHODS: Maternal and newborn hospital discharge records were linked to birth/death certificates for the 10-year period January 1, 1991, to December 30, 2000, for the majority (98%) of deliveries in California. This database was searched for the diagnosis of acute MI, demographic characteristics, and pregnancy outcomes. Patients were divided into 4 groups: antenatal diagnosis, intrapartum diagnosis, up to 6-week postpartum diagnosis, and those without the diagnosis of acute MI. All groups were compared by Student t test or chi(2) or both, where appropriate. RESULTS: A total of 151 women had an acute MI during the antepartum (38%), intrapartum (21%), or 6-week postpartum (41%) period, giving an incidence rate of 1 in 35,700 deliveries. The incidence rate increased over the study period. The maternal mortality rate was 7.3%, and maternal death only occurred in women with an acute MI before or at delivery (P < .01). Compared with women who did not have an acute MI, those with one were more likely to be older (30% were older than 35 years compared with 10%), multiparous (78% compared with 61%), non-Hispanic white (40% compared with 35%) or African Americans (15% compared with 7%). All measures of maternal and neonatal morbidity were increased in the acute MI group compared with those without an acute MI. Multivariate analysis identified chronic hypertension, diabetes, advancing maternal age, eclampsia, and severe preeclampsia as independent risk factors for acute MI. CONCLUSION: Acute MI during pregnancy remains a rare event, with significant maternal, fetal, and neonatal morbidity and mortality and maternal mortality limited to the antepartum and intrapartum period.