Acute myocardial infarction in twin pregnancy after assisted reproduction: A case report

Abstract

BACKGROUND Acute myocardial infarction (AMI) during pregnancy is rare, especially in twin pregnancy, and it can endanger the lives of the mother and children. Except for conventional cardiovascular risk factors, pregnancy and assisted reproduction can increase the risk of AMI during pregnancy. AMI develops secondary to different etiologies, such as coronary spasm and spontaneous coronary artery dissection. CASE SUMMARY A 33-year-old woman, with twin pregnancy in the 31 st week of gestation, presented to the hospital with intermittent chest tightness for 12 wk, aggravation for 1 wk, and chest pain for 4 h. Combined with the electrocardiogram and hypersensitive troponin results, she was diagnosed with acute ST-elevation myocardial infarction. Although the patient had no related medical history, she presented several risk factors, such as age greater than 30 years, assisted reproduction, and hyperlipidemia. After diagnosis, the patient received antiplatelet and anticoagulant treatment. Cesarean section and coronary angiography performed 7 d later showed stenosis and thrombus shadow of the right coronary artery. After receiving medication, the patient was in good condition. CONCLUSION This case suggests that, with the widespread use of assisted reproductive technology, more attention should be paid to perinatal healthcare, especially when chest pain occurs, to facilitate early diagnosis and intervention of AMI, and the etiology of AMI in pregnancy needs to be differentiated, especially between coronary spasm and spontaneous coronary artery dissection.

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

“…Also, few are known today for the safety of other antiplatelet agents in pregnancy, including clopidogrel and ticopidine. Clopidogrel, although still the most widely used thenopyridin during pregnancy, despite cases of cases have shown a correlation between the use of the clopidogrel of maternal thrombocytia, maternal bleeding and fetal loss [15] . Current guidelines do not provide several recommendations on adapting the double antiplatelet treatment to pregnant women.…”

“…The risk of acute myocardial infarction, although young in young women of childbearing age during pregnancy, due to the normal changes that characterize it, including blood hypertension, the risk increases significantly [3] . However, despite the increasing incidence of the disease observed in recent years during pregnancy and immediate postpartum period, acute myocardial infarction in pregnant women is an unusual but potentially destructive complication, with significantly increased rates and mortality [4] . Pregnancy associated acute myocardial infarction occurs at a frequency of approximately 0.06 to 10 cases per 100,000 births worldwide [5] .…”