Coronary angioplasty in pregnancy.

Abstract

SUMMARY Myocardial infarction is rare in pregnancy. A 30 year old white primigravida had an anterior infarct at 20 weeks' gestation, which was followed by troublesome angina. Coronary angiography showed a tight stenosis of the left anterior descending coronary artery. This was treated successfully by percutaneous transluminal coronary angioplasty.Case report A 30 year old white woman presented at 20 weeks' gestation in her first pregnancy with paraesthesiae and severe pain in her left arm and hand. This was followed by a dull feeling of intense retrosternal pressure radiating down both arms, which was associated with profuse sweating, nausea, and vomiting. There was no previous medical or drug history.The patient had smoked 30 cigarettes a day for fourteen years. Her father and paternal uncle had died after myocardial infarction aged 39 and 40 years respectively. There were no other associated risk factors for myocardial infarction.The patient was admitted from home directly to the coronary care unit of her local hospital. The first electrocardiogram showed unequivocal ST elevation in leads I and V2-V6. Because the symptoms persisted she was given intravenous diamorphine. While she was being examined cardiac ventricular fibrillation occurred. Cardiopulmonary resuscitation was performed and intravenous lignocaine was administered; four direct current shocks were required to restore sinus rhythm.Four days later further typical ischaemic chest pain occurred which did not settle despite intravenous infusion of isosorbide dinitrate. She was also treated with oral nifedipine 20 mg twice a day, atenolol 100 mg twice a day, slow release isosorbide dinitrate 20 mg twice a day, diazepam 2 mg three times a day, and potassium supplements. Urgent transfer to a regional cardiac centre was arranged.On arrival at the centre a 12 lead electrocardiogram showed diminished R waves in leads V1-V4, normal ST segments, and T wave inversion in lead Vl only. Ultrasonography showed a normal fetus. (fig 2a). During the procedure the fetus was protected by positioning lead aprons behind and over the anterior wall and flanks of the patient's abdomen. The radiographic screening time was kept as short as possible. Thermoluminescent dosimetry measurements of the radiation dose received by the patient's skin showed a maximum fetal dose of < 0-55 mSv. We assumed that a completed myocardial infarct had occurred. The patient's symptoms settled and a ten day postinfarct submaximal exercise test (equivalent to completing stage 1 of the Bruce protocol) was well tolerated. There were no cardiac symptoms or ST changes and there was a satisfactory rise in blood pressure. The test was performed on the same oral medication as that given before transfer to the regional centre, and she remained on this combination on discharge.Nine days after discharge she had further central chest pain. The patient was immediately admitted to the regional cardiac centre. The electrocardiogram showed deep T wave inversion in leads I, aVL, and V2-V6. Treatment with intraven...

Primary stent implantation for acute myocardial infarction during pregnancy: Use of abciximab, ticlopidine, and aspirin

“…Even though AMI during pregnancy is an indication for PTCA, experience is limited due to the rarity of AMI during pregnancy and the limited availability of coronary intervention for AMI worldwide. To date there are only nine reports of coronary interventions during pregnancy [4][5][6][7]11,[13][14][15][16]. Four of these were primary procedures for management of AMI [4][5][6][7].…”

A Rare Case of Acute Cerebrovascular Accident in the Post-Partum Period after Primary Angioplasty during Pregnancy

“…The salient features of the present case could be as follow: 1) Acute myocardial infarction in pregnancy is a very rare occurrence [1]; the present case is one of the very few cases reported from India so far; 2) The patient presented with acute onset of myocardial infarction during the second trimester, while majority of reported cases have depicted that pregnancy-related myocardial infarction is more common during the third-trimester [7]; 3) The symptom-to-door time in our patients was only 20 minutes; 4) our patient lacked conventional coronary risk factors [3] including gestational diabetes or eclampsia, except a family history of coronary artery disease; 5) While the most common cause for pregnancy-related acute myocardial infarction remains atherosclerosis or coronary dissection [7], our case displayed a distinct profile; and 6) An association of acute cerebrovascular event in the post-partum period post-primary PCI has not been reported so far.…”

“…The prognosis is often poor as high maternal mortality and fetal loss is frequently associated with pregnancy-related myocardial infarction [2]. Back in 1988, Cowan et al reported the first case of percutaneous coronary intervention (PCI) during pregnancy in a 30-year-old woman with myocardial infarction [3]. Since then, numerous cases of coronary angioplasty during pregnancy have been reported.…”

Acute infarction, intracoronary thrombolysis, and primary PTCA in pregnancy

“…An extensive literature search revealed only 5 cases of PTCA performed during pregnancy [7,9,19,20,26]. Our patient differed from these patients in several respects: she had no risk factors except for a smoking history discontinued prior to pregnancy, the culprit vessel was the LAD and it was totally occluded, there was evidence of additional thrombus in a significant branch of that vessel, and her cardiac recovery was potentially threatened with the need for an emergency cesarean section less than 2 wk after her infarct.…”