[Pulmonary oedema in pregnancy: myocardial infarction as a possible cause]

Pulmonary oedema in pregnancy may have various causes. A systematic approach to a pregnant woman with pulmonary oedema is important. Acute myocardial infarction should be considered during the differential diagnosis.

A 30-year-old primigravida, who had been admitted with pre-eclampsia, complained of increasing shortness of breath at 28 weeks and 5 days gestation. She had pulmonary oedema, which was considered to be consistent with pre-eclampsia. A caesarean section was performed at 28 weeks and 6 days gestation because of increasing oxygen dependency. Following the caesarean section the patient was transferred to the ICU because of imminent respiratory failure, and a semi-acute anterior infarction was diagnosed by means of an ECG (estimated ejection fraction: 30%). The patient was discharged in a reasonable condition 8 days after the caesarean section.

Differential diagnosis of pulmonary oedema during pregnancy is wide. Consultation with a cardiologist is recommended if a possible cardiac cause is suspected. Determination of troponin levels, ECG and an electrocardiogram should be the first diagnostic tools of choice in a pregnant patient.