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[Myocardial infarction during pregnancy].

P J Kulka1, C Scheu, M Tryba

  • 1Evangelisches Krankenhaus Oberhausen (EKO), Akademisches Lehrkrankenhaus, Universität Essen, Abteilung für Anästhesiologie und Intensivmedizin, Virchowstrasse 20, 46047 Oberhausen. Peter.Kulka@ruhr-uni-bochum.de

Der Anaesthesist
|May 18, 2001
PubMed
Summary

Myocardial infarction during pregnancy may stem from early coronary artery disease plaque rupture, not just spasms or dissection. Intravascular ultrasound revealed a ruptured atheroma in a case previously showing normal angiography.

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Area of Science:

  • Cardiology
  • Obstetrics
  • Vascular Biology

Background:

  • Myocardial infarction during pregnancy is rare, with coronary spasms often cited as the cause when angiography is normal.
  • Coronary artery dissection is another rare cause of myocardial infarction with normal angiography findings.

Observation:

  • A 31-year-old pregnant woman experienced myocardial infarction during cesarean section under spinal anesthesia.
  • Coronary angiography showed normal coronary vessels, but intravascular ultrasound revealed an atheroma with a ruptured fibrous cap in the left main coronary artery.
  • The patient had hypercholesterinemia, increased factor VII activity, and hyperfibrinogenemia, with impaired response to aspirin.

Findings:

  • This case suggests early-stage coronary artery disease with plaque rupture as a third potential cause of myocardial infarction during pregnancy.

Related Experiment Videos

  • Hypertension during anesthesia likely triggered plaque rupture, leading to myocardial infarction.
  • Intravascular ultrasound identified subclinical atherosclerosis not detectable by angiography.

    • Implications:

    • Myocardial infarction during pregnancy may be more frequently caused by plaque rupture than previously recognized.
    • Intravascular ultrasound is crucial for diagnosing early coronary artery disease stages during pregnancy.
    • Identifying and managing risk factors for coronary artery disease is vital in pregnant patients presenting with myocardial infarction.