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Myocardial infarction during pregnancy: management and outcome of two pregnancies
1Department of Obstetrics and Gynecology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27157-1066.
Objective:
Each year in the United States approximately 500,000 women die from ischemic heart disease. However, there are < 100 reported cases of myocardial infarction occurring during pregnancy. The current management of these patients is empiric, with pulmonary artery catheterization during labor being frequently reported.
Study Design:
In the past year we have managed and delivered two such patients, including the first reported case of myocardial infarction with a triplet gestation.
Results:
Both patients had clinical and laboratory signs of myocardial infarction and underwent coronary angiography. They subsequently had preeclampsia and were prematurely delivered of viable fetuses. One patient had angina pectoris during labor and was successfully treated with sublingual nitroglycerin. Neither patient suffered reinfarction or heart failure. Invasive hemodynamic monitoring was not used, and the mode of delivery was determined solely on obstetric indications.
Conclusion:
In pregnant patients with myocardial infarction, invasive central monitoring is unnecessary in patients with good cardiac function and reserve and the mode of delivery should be based on obstetric indications.