Myocardial Infarction in Pregnancy: What Should We Do?

Main Article Content

Sidhi Laksono
Tristi Lukita Wening

Abstract

Acute myocard infarct during pregnancy is a rare event with high mortality and women with cardiac comorbid such as hypercholesterolemia, hypertension, and history of myocardial infarction are one of risk that should be warning. However, the main etiology myocard infarct in pregnancy is spontaneous coronary artery dissection, especially in the third semester. Women with unusual chest pain, ST-elevation in electrocardiogram, and sudden cardiac arrest should treat as soon as possible. Patient with unstable condition revascularization is recommended. However, there are several things that should be monitor during revascularization such as consideration type of stent, how much contrast that will be use, and planning after stent implantation. Thrombolysis should be the last option because of bleeding risk. Therapy during and after pregnancy should be monitor continuously because of their side effect to mother and baby, and delivery in women with acute myocard infarct should be one of main concerns. With this review, we hope that we can raise our awareness in pregnant women with their comorbid and their future pregnancy.

Downloads

Download data is not yet available.

Article Details

How to Cite
1.
Laksono S, Lukita Wening T. Myocardial Infarction in Pregnancy: What Should We Do?. SEE J Cardiol [Internet]. 2024 Jan. 30 [cited 2024 Apr. 23];5:11-6. Available from: https://seejca.eu/index.php/seejca/article/view/6067
Section
General Cardiology

References

Merlo AC, Rosa GM, Porto I. Pregnancy-related acute myocardial infarction: A review of the recent literature. Clin Res Cardiol. 2022;111(7):723-31. https://doi.org/10.1007/s00392-021-01937-5 PMid:34510263 DOI: https://doi.org/10.1007/s00392-021-01937-5

Tweet MS, Lewey J, Smilowitz NR, Rose CH, Best PJ. Pregnancy-associated myocardial infarction. Circ Cardiovasc Interv. 2020;13(11). https://doi.org/10.1161/circinterventions.120.008687 PMid:32862672 DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.120.008687

Edupuganti MM, Ganga V. Acute myocardial infarction in pregnancy: Current diagnosis and management approaches. Indian Heart J. 2019;71(5):367-74. https://doi.org/10.1016/j.ihj.2019.12.003 PMid:32035518 DOI: https://doi.org/10.1016/j.ihj.2019.12.003

Balgobin CA, Zhang X, Lima FV, Avila C, Parikh PB, Yang J, et al. Risk factors and timing of acute myocardial infarction associated with pregnancy: Insights from the national inpatient sample. J Am Heart Assoc. 2020;9(21):e016623. https://doi.org/10.1161/jaha.120.016623 PMid:33106090 DOI: https://doi.org/10.1161/JAHA.120.016623

O’Kelly AC, Ludmir J, Wood MJ. Acute coronary syndrome in pregnancy and the post-partum period. J Cardiovasc Dev Dis. 2022;9:198. https://doi.org/10.3390/jcdd9070198 PMid:35877560 DOI: https://doi.org/10.3390/jcdd9070198

Lewey J, El Hajj SC, Hayes SN. Spontaneous coronary artery dissection: New insights into this not-so-rare condition. Annu Rev Med. 2022;73:339-54. https://doi.org/10.1146/annurev-med-052819-023826 PMid:35084994 DOI: https://doi.org/10.1146/annurev-med-052819-023826

Vongbunyong K, Chua F, Ghashghaei R. Pregnancy-related spontaneous coronary artery dissection: A rare cause of acute coronary syndrome in the third trimester. BMC Cardiovasc Disord. 2023;23(1):292. https://doi.org/10.1186/s12872-023-03323-7 PMid:37291481 DOI: https://doi.org/10.1186/s12872-023-03323-7

Cano-Castellote M, Afanador-Restrepo DF, González- Santamaría J, Rodríguez-López C, Castellote-Caballero Y, Hita- Contreras F, et al. Pathophysiology, diagnosis and treatment of spontaneous coronary artery dissection in peripartum women. J Clin Med. 2022;11(22):6657. https://doi.org/10.3390/jcm11226657 PMid:36431134 DOI: https://doi.org/10.3390/jcm11226657

Ramlakhan KP, Johnson MR, Roos-Hesselink JW. Pregnancy and cardiovascular disease. Nat Rev Cardiol. 2020;17(11):718-31. https://doi.org/10.1038/s41569-020-0390-z PMid:32518358 DOI: https://doi.org/10.1038/s41569-020-0390-z

Thobani A, Hassen L, Mehta LS, Agarwala A. Management of hypercholesterolemia in pregnant women with atherosclerotic cardiovascular disease. Curr Atheroscler Rep. 2021;23(10):58. https://doi.org/10.1007/s11883-021-00957-w PMid:34345940 DOI: https://doi.org/10.1007/s11883-021-00957-w

Cauldwell M, Baris L, Roos-Hesselink JW, Johnson MR. Ischaemic heart disease and pregnancy. Heart. 2018;105:189-95. https://doi.org/10.1136/heartjnl-2018-313454 PMid:30442741 DOI: https://doi.org/10.1136/heartjnl-2018-313454

Alameh A, Jabri A, Aleyadeh W, Nasser F, Al Abdouh A, Kondapaneni M, et al. Pregnancy-associated myocardial infarction: A review of current practices and guidelines. Curr Cardiol Rep 2021;23(10):142. https://doi.org/10.1007/ s11886-021-01579-z PMid:34410528 DOI: https://doi.org/10.1007/s11886-021-01579-z

Park K, Bortnick AE, Lindley KJ, Sintek M, Sethi S, Choi C, et al. Interventional cardiac procedures and pregnancy. J Soc Cardiovasc Angiograph Interv. 2022;1(5):100427. https://doi.org/10.1016/j.jscai.2022.100427 DOI: https://doi.org/10.1016/j.jscai.2022.100427

Davis E, Wood MJ. Pregnancy after spontaneous coronary artery dissection (SCAD): A 2020 update. Curr Treat Options Cardio Med. 2020;22:56. https://doi.org/10.1007/s11936-020-00858-2 DOI: https://doi.org/10.1007/s11936-020-00858-2

Elkayam U, Havakuk O. Acute myocardial infarction and pregnancy. In: Cardiac Problems in Pregnancy. 4th ed. United States: Wiley; 2019. p. 201-19. https://doi.org/10.1002/9781119409861.ch14 DOI: https://doi.org/10.1002/9781119409861.ch14

Colletti PM, Lee KH, Elkayam U. Cardiovascular imaging of the pregnant patient. Am J Roentgenol. 2013;200(3):515-21. https://doi.org/10.2214/AJR.12.9864 PMid:23436839 DOI: https://doi.org/10.2214/AJR.12.9864

Lal R. Drugs in Pregnancy and Lactation: Improved Benefit- Risk Information; 2015. Available from: https://www.fda. gov/downloads/drugs/developmentapprovalprocess/ smallbusinessassistance/ucm431132.pdf [Last accessed on 2023 Nov 16].

Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165-241. https://doi.org/10.1093/eurheartj/ehy340 PMid:30165544 DOI: https://doi.org/10.1093/eurheartj/ehy478

Purwowiyoto SL. Coronary drug-coated balloons: Should we choose a stentless approach? Adv Card Res. 2023;1(1):6-13. https://doi.org/10.5281/zenodo.8031627

Elkayam U, Goland S, Pieper PG, Silversides CK. High-risk cardiac disease in pregnancy: Part I state of the art review. J Am Coll Cardiol. 2016;68(4):396-410. https://doi.org/10.1016/j.jacc.2016.05.048 PMid:27443437 DOI: https://doi.org/10.1016/j.jacc.2016.05.048

Halpern DG, Weinberg CR, Pinnelas R, Mehta-Lee S, Economy KE, Valente AM. Use of medication for cardiovascular disease during pregnancy: JACC state-of-the-art review. J Am Coll Cardiol. 2019;73:457-76. https://doi.org/10.1016/j.jacc.2018.10.075 PMid:30704579 DOI: https://doi.org/10.1016/j.jacc.2018.10.075

Mehta LS, Warnes CA, Bradley E, Burton T, Economy K, Mehran R, et al. Cardiovascular considerations in caring for pregnant patients: A scientific statement from the American Heart Association. Circulation. 2020;141(23):e884-903. https:// doi.org/10.1161/cir.0000000000000772 DOI: https://doi.org/10.1161/CIR.0000000000000772

Sun P, Liang XQ, Hong T, Zhang H. Perioperative management of acute myocardial infarction in the 31st week of pregnancy: A case report and literature review. Front Ismail S, Wong C, Rajan P, Vidovich MI. ST-elevation acute myocardial infarction in pregnancy: 2016 update. Clin Cardiol. 2017;40(6):399-406. https://doi.org/10.1002/clc.22655 PMid:28191905 DOI: https://doi.org/10.1002/clc.22655

Surg.2022;9:1023551.https://doi.org/10.3389/fsurg.2022.1023551 PMid:36406366 DOI: https://doi.org/10.3389/fsurg.2022.1023551

Elkayam U, Jalnapurkar S, Barakkat MN, Khatri N, Kealey AJ, Mehra A, et al. Pregnancy-associated acute myocardial infarction. Circulation. 2014;129(16):1695-702. https://doi.org/10.1161/circulationaha.113.002054 DOI: https://doi.org/10.1161/CIRCULATIONAHA.113.002054