Acute myocardial infarction during pregnancy

We describe the case of a 27-year-old primigravida with an unremarkable medical history and no risk factors for coronary artery disease. At 28 weeks she received tocolytic therapy, first with ritodrine, subsequently with nifedipine for preterm labour. In addition she developed an uncomplicated non-Q wave anterolateral myocardial infarction. A coronary angiography performed 2 days after the acute event was normal. The further course was uneventful with a spontaneous vaginal delivery at 40 weeks. We reviewed the literature concerning the incidence of acute myocardial infarction during pregnancy, its physiologic backgrounds and the possible association with use of tocolytic therapy, sympathomimetic agents in particular. The impact of pregnancy on maternal haemodynamics is generally underestimated, which makes an early diagnosis often difficult. Future research has to define the specific role of currently available treatment options, including cardiac catheterization and more recently developed pharmacologic interventions. Obviously, foetal considerations will greatly influence the selection of different approaches.