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Pregnancy-associated myocardial infarction

Case report and review of the literature

Schwangerschaftsassoziierter Herzinfarkt

Fallbericht und Literaturübersicht

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Abstract

Acute myocardial infarction (AMI) is a rare, but possibly catastrophic event during pregnancy, delivery, or puerperium, leading to a high mortality rate. It has different pathogenic mechanisms, such as atherosclerosis, vasospasm, thrombosis, and coronary dissection. Although MI has been reported in pregnant women at all stages of pregnancy and postpartum, it occurs more commonly in the third trimester. Pregnancy-associated MI most commonly involves the anterior wall. Pregnancy itself is an independent risk factor for MI, conferring a fourfold higher risk than that of nonpregnant women matched for age. We report the case of a 27-year-old primigravida at 30 weeks’ gestation presenting with anterior MI, secondary to severe stenosis of the left anterior descending coronary artery, treated with emergency percutaneous coronary intervention.

Zusammenfassung

Ein akuter Herzinfarkt ist ein seltenes, aber mögliches schweres Ereignis im Verlauf einer Schwangerschaft, einer Entbindung oder des Wochenbetts und führt zu einer hohen Mortalitätsrate. Ihm liegen verschiedene Pathomechanismen zugrunde, z. B. Arteriosklerose, Vasospasmus, Thrombose und Koronardissektion. Zwar sind Herzinfarkte bei schwangeren Frauen in allen Stadien der Schwangerschaft und postpartal beschrieben worden, aber im 3. Trimenon treten sie häufiger auf. Ein schwangerschaftsassoziierter Herzinfarkt betrifft zumeist die Vorderwand. Die Schwangerschaft an sich stellt einen unabhängigen Risikofaktor für einen Herzinfarkt dar, der ein 4-fach erhöhtes Risiko gegenüber nichtschwangeren Frauen entsprechenden Alters bedeutet. Hier wird der Fall einer 27-jährigen Frau mit einem Vorderwandinfarkt infolge einer schweren Stenose des Ramus interventricularis anterior mit notfallmäßiger perkutaner Koronarintervention in der 30. Schwangerschaftswoche ihrer 1. Schwangerschaft beschrieben.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Cardiology Clinic, Kartal Koşuyolu Heart&Research Hospital, Denizer Cad. Cevizli, 34846, Kartal-İstanbul, Turkey

    T. Bezgin MD, Ç. Geçmen, İ. Erden & A.M. Esen

Authors
  1. T. Bezgin MD
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  2. Ç. Geçmen
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  3. İ. Erden
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  4. A.M. Esen
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Corresponding author

Correspondence to T. Bezgin MD.

Additional information

Additional material onlineThis article includes six additional videos. You will find this supplemental at dx.doi.org/10.1007/s00059-013-3856-5.

Electronic supplementary material

Video 1: Parasternal long axis showing hypokinesia in mid and anterior septum. (AVI 12MB)

Video 2: Parasternal short axis revealing severe hypokinesia in the apex of left ventricle. (AVI 8MB)

59_2013_3856_MO3_ESM.avi

Video 3: Caudal right anterior oblique projection shows near total occlusion of the mid to distal LAD with severe stenosis of the proximal LAD and normal left circumflex artery. (AVI 15MB)

59_2013_3856_MO4_ESM.avi

Video 4: Left lateral projection shows diffuse narrowing and thinning of the LAD resembling transplant vasculopathy. (AVI 14MB)

59_2013_3856_MO5_ESM.avi

Video 5: Caudal right anterior oblique projection shows a reasonable result of stenting the mid to distal LAD lesions. (AVI 13MB)

Video 6: Coronary angiography shows optimal result after 4 stent implantation to the proximal LAD. (AVI 42MB)

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Bezgin, T., Geçmen, Ç., Erden, İ. et al. Pregnancy-associated myocardial infarction. Herz 39, 530–533 (2014). https://doi.org/10.1007/s00059-013-3856-5

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  • DOI: https://doi.org/10.1007/s00059-013-3856-5

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