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Cardiovascular disease is the leading indirect cause of maternal mortality in the UK. Pregnancy increases the risk of acute MI (AMI) by three- to fourfold secondary to the profound physiological changes that place an extra burden on the cardiovascular system. AMI is not always recognised in pregnancy and there is concern among both clinicians and p...
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... Pregnant women with hemodynamic instability associated with NSTEMI and non responsive to medical management are preferred to [11][12][13][14][15][16] undergo PCI . Acute myocardial infarction (AMI) due to vasospasm 14,[17][18][19][20] is less common. ...
Background: Atherosclerotic disease is the most common cause of acute coronary syndrome (ACS) in general population. Spontaneous coronary artery dissection is the most common cause of coronary artery disease (CAD) in pregnancy. Arterial thrombosis is rare in pregnancy. Hypercoagulable state in pregnancy leads to thrombosis in predisposed individuals. Various other risk factors include dyslipidemia, diabetes, hypothyroidism, high maternal age, hormone therapy. Being a case report the study was c Methods: onducted at SDM Medical College, Dharwad, Karnataka, India, based on a patient came to Emergency Room (ER) in August 2021. We analysed the case to nd out the signicance of emergency medical management of ACS in pregnancy. A woman of term pregnancy came to ER with chest pain was evaluated with electrocardiogram (ECG) and shortness of breath prole (SOB). ECG and SOB was suggestive of Non ST segment elevation myocardial infarction (NSTEMI). The patient was evaluated with echocardiography and angiography. Angiography showed distal left anterior descending artery (LAD) thrombosis. Patient was treated with antiplatelets and anticoagulants without the need of thrombolysis or angioplasty. Lower segment caesarean section (LSCS) was the mode of delivery. Maternal and fetal wellbeing was assured through prompt dia Conclusion: gnosis and management in ER.
... On the basis of the scientific data to date, there is no consent of researchers who have particularly dealt with the subject regarding the optimal management of pregnant women with acute myocardial infarction and thrombolytic treatment. Various attempts to deal with the condition have been described in numerous cases of incidents using intraceanic thrombolysis, suction catheter and stent placement with a variety of success [20] . ...
Acute myocardial infarction in pregnant women is an uncommon but potentially devastating complication with significantly increased rates of maternal and perinatal morbidity and mortality. The treatment of acute coronary syndrome in pregnancy is a unique clinical challenge. Published data on the use of thrombolytic drugs, percutaneous coronary intervention, coronary artery bypass grafting and optimal medical management of ischemic heart disease in pregnancy are limited. This article attempts to review acute myocardial infarction in pregnancy, regarding the basic treatment principles, the timely and correct application of which can yield the best possible result for the mother and the fetus and the newborn.
... The choice of coronary revascularization through PCI depends on the type of AMI (NSTEMI vs STEMI), suspected etiology (eg, atherosclerotic, PASCAD, thrombus, and vasospasm) and timing of event relative to delivery. 71,84 Challenges remaining with the use of PCI in pregnancy include the optimal type of stent to use, duration and selection of antiplatelet therapy, and the highrisk nature of PCI in SCAD. 39,57,84 Indications. ...
... 71,84 Challenges remaining with the use of PCI in pregnancy include the optimal type of stent to use, duration and selection of antiplatelet therapy, and the highrisk nature of PCI in SCAD. 39,57,84 Indications. Urgent reperfusion therapy by PCI is the gold standard for treatment of STEMI in both pregnant and non-pregnant patients. ...
... 79,80 PCI in PASCAD is recommended over conservative management only in selected high-risk cases, defined as ongoing ischemia, left main artery dissection, or hemodynamic instability. 19,40,84 PCI in SCAD is associated with a high risk of complications and suboptimal outcomes, as affected arteries are more prone to iatrogenic dissection and further extension of dissection. 19 Stent Selection. ...
Cardiovascular disease, and particularly ischemic heart disease, is a leading cause of maternal morbidity and mortality in high-income countries. The incidence of acute myocardial infarction (AMI) has been rising over the past two decades due to increasing maternal age and a higher prevalence of cardiovascular risk factors in the pregnant population. Causes of AMI in pregnancy are diverse and may require specific considerations for their diagnosis and management. In this narrative review, we provide an overview of physiologic changes, risk factors, and etiologies leading to AMI in pregnancy, as well as diagnostic tools, reperfusion strategies, and pharmacological treatments for this complex population. In addition, we outline considerations for labor and delivery planning and long-term follow-up of patients with AMI in pregnancy.
... Cardiovascular diseases rank as the leading cause of pregnancy-related deaths in the United States, accounting for more than 15% of such deaths in the recent years, as reported by the Centers for Disease Control and Prevention. Notoriously, gestation heightens the risk of acute myocardial infarction (AMI) about threefold, owing to its associated hypercoagulability and hypervolaemia, which in turn increase heart rate, cardiac output, blood pressure, and myocardial oxygen consumption [1][2][3]. Moreover, according to recent evidence, pregnancy-related AMI and cardiovascular mortality are growing worldwide [4]. ...
... Regarding coronary spasm, pre-eclampsia is a strong risk factor, as it causes systemic endothelial dysfunction owing to imbalance in the secretion of endothelin and thromboxane [38]. Other possible mechanisms in pregnancy include enhanced vascular reactivity to angiotensin II and noradrenaline, and renin and angiotensin release because of decreased uterine perfusion in the supine position [2]. ...
Pregnancy-related acute myocardial infarction is a rare and potentially life-threatening cardiovascular event, the incidence of which is growing due to the heightened prevalence of several risk factors, including increased maternal age. Its main aetiology is spontaneous coronary artery dissection, which particularly occurs in pregnancy and may engender severe clinical scenarios. Therefore, despite frequently atypical and deceptive presentations, early recognition of such a dangerous complication of gestation is paramount. Notwithstanding diagnostic and therapeutic improvements, pregnancy-related acute myocardial infarction often carries unfavourable outcomes, as emergent management is difficult owing to significant limitations in the use of ionising radiation—e.g. during coronary angiography, potentially harmful to the foetus even at low doses. Notably, however, maternal mortality has steadily decreased in recent decades, indicating enhanced awareness and major medical advances in this field. In our paper, we review the recent literature on pregnancy-related acute myocardial infarction and highlight the key points in its management.
... При СДКА КГ является методом диагностической визуализации первой линии. Йодированный контрастный материал может проникать через плаценту и попадать в плод, но не сообщается о его тератогенных эффектах [54]. Другой проблемой является потенциальный риск врожденного гипотиреоза плода [7,31]. ...
... Для определения оптимальной тактики лечения, включая реваскуляризацию миокарда (РМ), учитывается состояние матери и плода. Выживание плода зависит от стабилизации состояния матери [28,54]. ИМ, развившийся во время беременности, является показанием к отсрочке родов. ...
... Вместе с тем, учитывая относительно высокую частоту осложнений и «неудачных» ЧКВ при беременности, консервативное лечение рекомендуется женщинам с низким РС и особенно женщинам с СДКА [6]. Относительно прогноза наиболее благоприятное время для выполнения ЧКВ -после 4-го месяца [54]. Риск облучения плода наиболее высок в I триместре. ...
Lately due to the increase of childbearing age of women, high prevalence of cardiovascular diseases, and, presumably, due to the usage of some medications, there was an increase in myocardial infarction (MI) cases in pregnant women. Risk factors and pathophysiological mechanisms of MI in pregnant women differ from the general population, and are heterogeneous. Pregnancy and childbirth can be defined as ‘physiological stress’ for the cardiovascular system, which can cause MI. Abrupt changes in hemodynamics and increased coagulation state during pregnancy, in childbirth or in the early postpartum period can provoke sudden constriction (vasospasm) of a coronary artery (CA), as well as non-atherosclerotic spontaneous CA dissection, which leads to a critical decrease in the supply of oxygen to the heart muscle. The frequency of hemodynamically significant atherosclerosis of CA is also increasing. The incidence of maternal, perinatal mortality and obstetric complications is higher than in women without history of acute coronary syndrome. Over the past few decades, the diagnosis and treatment of myocardial infarction improved, the number of primary percutaneous coronary interventions in pregnant women increased, and there is now less inpatient mortality. However, due to the absence of large randomized clinical trials on the MI in pregnant women it is impossible to develop a unified algorithm for the management and preventive measures for this condition, thereby it is difficult to select an optimal treatment tactic, and hard to predict subsequent cardiovascular events. In this article we analyzed current data on MI during pregnancy, childbirth, and the postpartum period.
... Moreover, pre-eclampsia heightens the risk of coronary spasm, since it provokes endothelial dysfunction due to an imbalance in the release of endothelin and thromboxane (59). Pregnancyrelated coronary spasm may also result from enhanced vascular reactivity to some hormones, such as angiotensin II and noradrenaline (60). ...
Myocardial infarction with non-obstructive coronary arteries (MINOCA), despite a lower burden of coronary atherosclerosis, has a non-negligible prognostic impact. The label of MINOCA includes an array of different aetiologies and pathologic conditions, thus the identification of the underlying disease is crucial to patient management. Myocardial infarction with obstructive coronary artery disease and MINOCA share only some risk factors and comorbid conditions. While traditional cardiovascular risk factors have a lower prevalence in MINOCA patients, atypical ones—e.g., anxiety, depression, and autoimmune diseases—are much more frequent in this population. Other conditions—e.g., pregnancy, cancer, and anti-cancer therapy—can predispose to or even induce MINOCA through various mechanisms. The evidence of such risk factors for MINOCA is still scarce and contradicting, as no randomised controlled trials exist in this field. In our work, we performed a review of registries, clinical studies, and case reports of MINOCA, in order to summarise the available data and analyse its possibile pathogenic mechanisms.
... In this special focus issue, Khaing et al. describe in their review that the risk of acute coronary syndrome (ACS) increases by three-to fourfold during pregnancy, especially in women aged >40 years. 2 Although there is no evidence that in vitro fertilisation affects this risk, it is important to note that >90% of ACS in pregnancy occurs in women without prior IHD and that a coronary angiogram is done in fewer than half of all cases of ACS. In young women it is more important than ever to correctly assess the underlying pathophysiology to be able to provide the most appropriate treatment advice. ...
Cardiovascular disease is the primary driver of maternal mortality in the United States. Acute coronary syndrome (ACS) in pregnancy is increasing in prevalence and a source of substantial morbidity and mortality. The primary cause of pregnancy associated myocardial infarction (PAMI) is non-atherosclerotic pregnancy-associated spontaneous coronary artery dissection (p-SCAD); however, due to the unique hormonal and pro-thrombotic state of pregnancy, coronary atherothrombosis, coronary vasospasm, and coronary emboli are also common causes of ACS in pregnancy. Women with pregnancy complicated by ACS should be managed by a multidisciplinary cardio-obstetrics team with expertise in the safe and timely diagnosis and management of ACS in pregnancy. Despite the limited data regarding the safety profile of cardiac medications used in the treatment of ACS, pregnant women should be treated with guideline-directed medical therapies, with few exceptions. Pregnant women with ST elevation MI (STEMI) and high-risk non-STEMI (NSTEMI) including refractory symptoms, heart failure, arrhythmias, or cardiogenic shock should all be considered for early invasive coronary angiography with possible revascularization. Given the risk of dissection propagation with coronary interventions and the natural history of spontaneous healing of most SCAD lesions, conservative management is favored in most patients with p-SCAD. Women with a history of ischemic heart disease and SCAD are at risk for recurrent ACS and recommendations regarding subsequent pregnancies should be individualized (Central Illustration).KeywordsPregnancyAcute coronary syndromeMyocardial infarctionSpontaneous coronary artery dissectionCoronary angiographyPercutaneous coronary intervention
Cardiac arrest (CA) in pregnancy is a rare event and mortality (death during pregnancy, childbirth, or in the 42 days after delivery) in developed countries occurs in an estimated 1:12,000 admissions for delivery. CA in pregnancy is one of the most challenging clinical scenarios. We must consider that when an adverse cardiovascular event occurs in a pregnant woman there are two patients, the mother and the fetus and fetal survival usually depends on maternal survival.KeywordsCardiac arrest in pregnancySimulationCardiopulmonary resuscitation (CPR)Aortocaval compressionAspiration riskCardiac disease
Coronary events in pregnancy are a rare but growing cause of maternal morbidity and mortality. Pregnancy presents unique challenges across a broad spectrum of disciplines and requires a multidisciplinary approach to optimize maternal and fetal outcomes. The early involvement of the "cardio-obstetrics" team in pre-pregnancy counselling, the antenatal period, delivery and post-partum is vital to ensuring better outcomes for patients at high risk of coronary pathology. The overall risk for coronary events complicating pregnancy is increasing due to a number of factors including advancing maternal age and increases in traditional cardiac risk factors; contributing to higher rates of maternal morbidity and mortality. The majority of pregnant women experiencing a coronary event do not have prior coronary disease, and the pathological mechanisms involved are predominantly non-atherosclerotic. Diagnosis and management should follow standard guideline-based practices for acute coronary syndrome (ACS), including the use of diagnostic coronary angiography to guide percutaneous intervention when needed. Management of ACS should not be delayed to facilitate delivery, which can proceed following stent implantation and dual antiplatelet therapy. The timing and mode of delivery should be based on assessment of maternal and fetal status, but vaginal delivery is preferred when possible. This review aims to provide an overview of the major etiologies, risk factors, diagnosis and management strategies for patients at risk of or presenting with coronary events in pregnancy.
