Postpartum myocardial infarction in a patient with antiphospholipid syndrome

Myocardial infarction in association with pregnancy in patients with the antiphospholipid syndrome has been reported once previously. Our patient, a 22-year-old multiparous woman, experienced a myocardial infarction in the postpartum period. She fulfilled the criteria for the diagnosis of the antiphospholipid syndrome (elevated anticardiolipin antibody levels, false-positive syphilis serology, history of deep vein thrombosis). Cardiac catheterization demonstrated appropriate central filling pressures, cardiac output of 7.14 L/min, and normal-appearing coronary arteries. She was treated with corticosteroids and indomethacin and recovered. Our article is relevant to clinical practice for the following reasons. First, it is the second time myocardial necrosis has been reported in a recently pregnant woman with the antiphospholipid syndrome. Second, the finding of normal-appearing coronary arteries at the time of catheterization lends credence to the hypothesis that either vasospasm or thrombosis are the inciting events. We speculate on the utility of various treatment regimens.