Clinical case of a 29 weeks pregnant patient with ST-segment elevation myocardial infarction

Abstract

HighlightsThis clinical case describes the management of a 29 weeks pregnant patient with myocardial infarction. The material will be useful for cardiologists, physicians, obstetricians and gynecologists, and endovascular surgeons.  AbstractUnavoidable drastic changes in lifestyle due childbirth are pushing women to postpone it to an older age, thus increasing the risk of coronary artery disease (CAD) in pregnant women. This can be a problem not only for patients, but also for specialists. Currently there are 3-6 cases of acute coronary syndrome (ACS) per 100 thousand pregnancies, meaning such cases occur rarely in real clinical practice. Discomfort in the chest area does not directly indicate cardiac problem, so women do not visit cardiologist right away, and thus ACS remains undiagnosed. Besides traditional risk factors for CAD (age, dyslipidemia, smoking, physical inactivity), there are some additional obstetric factors: preeclampsia, thrombophilia and postpartum bleeding. About 40% of patients have myocardial infarction in the third trimester. Atherosclerosis is the most common cause of ACS, with coronary artery spasms, coronary artery dissection and thrombosis following behind. Currently the maternal mortality due to MI has decreased from 20% to 5% due to introduction of the percutaneous coronary intervention (PCI) into the treatment of ACS. There are not enough data on the use of thrombolytics and other medicine in the treatment of CAD, because pharmacological therapy can be dangerous in the early pregnancy at the peak of organogenesis. Moreover, PCI should be used with caution due to harmful effects of radiation on the pregnant woman and the fetus. The main task in later stages of pregnancy is to balance out the risk of stent thrombosis upon discontinuing double antiplatelet therapy and bleeding during childbirth and in the postpartum period. This article describes a clinical case of a 29 weeks pregnant patient with myocardial infarction.