Diagnostic Angiograms and Percutaneous Coronary Interventions in Pregnancy

Khaing, Phyo; Kunadian, Vijay

doi:10.15420/icr.2020.02

Cited by 10 publications

(14 citation statements)

References 79 publications

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“…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 ). Pregnancy-related coronary spasm may also result from enhanced vascular reactivity to some hormones, such as angiotensin II and noradrenaline ( 60 ).…”

Section: Risk Factors and Comorbiditiesmentioning

confidence: 99%

Myocardial Infarction With Non-obstructive Coronary Arteries: Risk Factors and Associated Comorbidities

Merlo

Troccolo

Piredda

et al. 2022

Front. Cardiovasc. Med.

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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.

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Section: Risk Factors and Comorbiditiesmentioning

confidence: 99%

Myocardial Infarction With Non-obstructive Coronary Arteries: Risk Factors and Associated Comorbidities

Merlo

Troccolo

Piredda

et al. 2022

Front. Cardiovasc. Med.

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“…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 ].…”

Section: Pathogenesismentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

Pregnancy-related acute myocardial infarction: a review of the recent literature

2021

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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.

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“…1,2,45 Coronary embolism typically affects the left heart system, owing to the larger diameter of the left main and greater proportion of blood flow it receives. 46,47 Coronary embolism can be classified as direct, paradoxical or iatrogenic. 46 Direct emboli arise from a cardiac source such as the left atrial appendage, left ventricle, or aortic or mitral valve.…”

Section: Coronary Thrombosismentioning

confidence: 99%