Acute coronary syndrome and preeclampsia

Myocardial ischemia and infarction are rare during pregnancy. Approximately 150 cases of myocardial infarction during pregnancy have been documented in the literature worldwide (predominantly anterior wall). However, elevated troponin levels have been reported in patients with preeclampsia.

We describe 2 patients with preeclampsia who presented with acute myocardial ischemia; 1 with ST segment elevation and one non-ST segment elevation at EKG. Our patients clearly had acute coronary syndromes with troponin levels much higher than would be accounted for by preeclampsia.

From the existing body of literature regarding this patient population, it is unclear why there is a higher incidence of adverse myocardial events. It may be that coronary ischemia has been missed in patients with preeclampsia. Troponin I is now readily available for detection of myocardial damage and should be used in this patient population only when clinically indicated, such as when chest discomfort or new electrocardiogram changes are observed. Patients with preeclampsia may be at higher risk for coronary events, and troponin I levels could be a valuable tool with which to monitor women who develop related symptoms.