Acute Coronary Syndrome in Pregnancy and the Post-Partum Period

Abstract

Cardiovascular disease is the leading cause of maternal mortality in the United States. Acute coronary syndrome (ACS) is more common in pregnant women than in non-pregnant controls and contributes to the burden of maternal mortality. This review highlights numerous etiologies of chest discomfort during pregnancy, as well as risk factors and causes of ACS during pregnancy. It focuses on the evaluation and management of ACS during pregnancy and the post-partum period, including considerations when deciding between invasive and non-invasive ischemic evaluations. It also focuses specifically on the management of post-myocardial infarction complications, including shock, and outlines the role of mechanical circulatory support, including veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Finally, it offers additional recommendations for navigating delivery in women who experienced pregnancy-associated myocardial infarction and considerations for the post-partum patient who develops ACS.

Bicoastal Spontaneous Coronary Artery Dissection: A Therapeutic Dilemma

“…While there are no data to guide the decision for vaginal or cesarean delivery in SCAD, in general for antepartum ACS, vaginal delivery is not contraindicated if pursued more than 2 weeks from the cardiac event. 9 Vaginal delivery is generally preferred in individuals with structural heart disease due to more gradual hemodynamic shifts, lower risk for infection, and thrombosis. The decision to perform a cesarean delivery for cardiac indications should be individualized for each patient and consider timing of infarction with respect to gestational age, the extent of infarction, and the presence of congestive heart failure or instability.…”

Myocardial Infarction in Pregnancy: What Should We Do?

“…Patients known to have coronary artery disease (CAD) in the past time had a greater chance of a heart attack, approximately 27-43% of myocardial infarctions are caused by atherosclerotic CAD. According to Cauldwell et al, women with underlying atherosclerotic disease during pregnancy are significantly older and have a higher body mass index, other significant CAD risk factors whereas patients with normal coroner have an MI with a non-obstructive coronary artery [5]. Spontaneous coronary dissection (SCAD) is the most common nonobstructive myocardial infarction in pregnancy with an estimated 14-43% [5].…”

“…Coronary vasospasm in pregnancy is estimated at 2-5% in pregnancy-associated MI [5]. Pre-eclampsia is one of the risk factors, resulting in a high-resistance uteroplacental circulation and will cause placental ischemia which impairs the function of maternal vascular endothelial growth factor resulting in systemic endothelial dysfunction.…”

Pregnancy related acute myocardial infarction: Current trends in treatment and future prospects

“…The most appropriate medication for pregnant patients with ischemic heart disease or acute myocardial infarction remains unknown, although it should not generally differ with some mildly disclosures from the acute coronary syndrome guidelines [12] . Low doses of aspirin inhibit thromboxane synthesis and act protective-antiplatelet, while high doses have been associated with fetal complications, such as perinatal mortality, delayed fetal development, premature and premature convergence.…”