Intrauterine myocardial infarction: unsuspected diagnosis in the delivery room

We present a case study of intrauterine myocardial infarction. A female neonate suffered from cardiopulmonary arrest at birth. She presented with refractory cardiogenic shock and died. Echocardiogram showed absence of movement of the posterolateral wall of the left chamber. Autopsy showed severe and extensive myocardial necrosis confined by a band of dystrophic calcification that suggested intrauterine origin. The circumflex artery and anterior descending coronary artery both presented with very narrow calibers. Sympathicomimetics administered to the mother also could have played a role in the development of infarction. Myocardial infarction should be suspected if signs of ischemia are present and there is no clear hypoxic-ischemic insult around delivery. Prognosis is poor especially if the main stem of the left coronary is involved. Cardiac transplantation can be considered.