Acute myocardial infarction in a 35-year-old postpartum woman

A 35-year-old postpartum woman was transferred to our emergency room because of severe precordial pain on the 49th day after delivery. Her ECG up on admission showed ST elevations in leads II, III, and aVF, and an emergency coronary angiography (CAG) demonstrated thrombosis in segment #1 and obstruction in segment #2 of the right coronary artery. Although percutaneous transluminal coronary angioplasty (PTCA) was performed immediately to dilate the stenotic and obstructive regions with balloons, it was not possible to achieve sufficient coronary blood flow TIMI grade 3 coronary blood flow was restored, however, through intracoronary thrombolysis. Three months after the onset of acute myocardial infarction (AMI), no significant stenosis was detected by CAG. However, a later CAG showed that the administration of acetylcholine induced spasm at the entrance and in segments # 2 and #4 of the right coronary artery. In our patient, the presence of both a vasospastic tendency and thrombophilia might have been a leading cause of the AMI, and this finding may be useful in determining future therapeutic tactics for postpartum AMI.