Acute myocardial infarction associated with pregnancy

Area of Science:

• Cardiology
• Obstetrics
• Maternal-Fetal Medicine

Background:

• Acute myocardial infarction (AMI) during pregnancy or the early postpartum period is a rare but critical obstetric emergency.
• Normal physiological changes during pregnancy can mask or mimic symptoms of AMI, delaying diagnosis.

Purpose of the Study:

• To review the epidemiology, etiology, diagnosis, prognosis, and treatment of AMI in pregnant and early postpartum women.
• To develop evidence-based guidelines for managing this high-risk condition.

Main Methods:

• Comprehensive literature search including MEDLINE, Index Medicus, and manual bibliography review.
• Inclusion of published reports and well-documented cases of AMI during pregnancy or the early postpartum period.
• Analysis of 125 identified cases to determine incidence, risk factors, and outcomes.

Main Results:

• Highest incidence observed in the third trimester and in multigravid women over 33 years old.
• Maternal mortality rate was 21%, with deaths often linked to labor and delivery.
• Coronary artery findings included atherosclerosis (43%), dissection (16%), and normal arteries (29%), particularly in peripartum/postpartum cases.

Conclusions:

• AMI in pregnancy/postpartum is rare but carries significant maternal and fetal risk.
• Diagnosis is often delayed due to pregnancy-related symptoms and low clinical suspicion.
• Management necessitates adherence to standard AMI protocols, with critical adjustments for fetal safety in diagnostic and therapeutic decisions.