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

Abstract

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.

Peripartum cardiomyopathy or acute myocardial infarction: how to face the challenge?

“…PMI is a rare entity that mostly presents with STEMI. The etiology of PMI includes coronary artery dissection, and less often atherosclerosis, thrombosis, or coronary vasospasm [1]. Our patient had no classic risk factors.…”

“…The repeated TTE showed an increase in EF to 35% within the next few days and the presence of segmental wall motion abnormalities -akinesis of the basal and middle segments of the lateral and inferolateral wall and moderate functional mitral valve regurgitation. Cardiac magnetic resonance (CMR) demonstrated regional akinesia limited to the corresponding area to TTE with a delayed subendocardial (>70% wall thickness) contrast S1] [1][2]. The arrhythmic presentation was reported in 19% of women with PPCM [2][3].…”

Perioperative management of acute myocardial infarction in the 31st week of pregnancy: A case report and literature review

“…According to previous research, the radiation exposure of patients during procedures such as coronary angiography is estimated to be <20 mGy, while the fetal share of radiation is estimated to be 0.074 mGy. At doses below 50 mGy, there is a negligible risk of fetal teratogenicity following radiation exposure, while fetal damage may occur at doses above 150 mGy ( 2 ). Therefore, we believe that the radiation dose in coronary angiography is safe for most pregnant patients.…”

“…Pregnancy-related acute myocardial infarction (PAMI) is relatively infrequent but is associated with notable maternal or fetal morbidity and mortality ( 1 ). The incidence of PAMI ranges from 0.06 to 10 per 100,000 pregnant women globally ( 2 ), with a case-fatality rate of 4.3% to 37% ( 3 – 5 ). The rate of PAMI is growing over time due to multiple reasons, such as rising maternal age and increased prevalence of obesity and diabetes ( 6 ).…”

“…The rate of PAMI is growing over time due to multiple reasons, such as rising maternal age and increased prevalence of obesity and diabetes ( 6 ). Spontaneous coronary artery dissection (SCAD) is a main etiology of PAMI and has been reported to occur in 15% to 40% of acute coronary syndrome (ACS) cases during pregnancy ( 2 ). To date, there are still many gaps in the understanding of PAMI, as guidelines for the management of PAMI are still limited ( 7 ).…”