The cardiac, obstetric, and anesthetic management of pregnancy complicated by acute myocardial infarction

Coronary artery disease and myocardial infarction in pregnancy: A review of epidemiology, diagnosis, and medical and surgical management

“…Tachycardia and hypertension should be promptly corrected. Ephedrine is usually the vasopressor agent of choice for hypotension associated with regional anesthesia because it helps maintain placental perfusion (41). Ergot alkaloids immediately after delivery should be avoided because of the risk of coronary artery spasm.…”

“…The associated risks probably depend on a number of factors including residual left ventricular function, coronary anatomy, ongoing myocardial ischemia, and the time between myocardial infarction and previous pregnancy (1,41). A full cardiac evaluation including electrocardiogram, stress test, echocardiography and assessment of the coronary arteries should be pursued preconception.…”

Anesthesia for the parturient with cardiovascular disease

“…Additionally, supplementation of a dilute local anesthetic solution with an epidural opioid has been advocated. 45 Fetal descent during the second stage of labor should be by force of uterine contraction, with avoidance of the Valsalva maneuver, according to the patient's baseline ejection fraction and analysis of the hemodynamic response to contractions. When epidural analgesia for the first stage of labor is not employed, a low spinal anesthetic (saddle block) provides excellent conditions for an assisted delivery with minimal hemodynamic trespass.…”

Pregnancy-Related Acute Myocardial Infarction: A Review of Epidemiology, Diagnosis, Medical And Surgical Management

“…Main concern in primary PCI is radiation and need to dual antiplatelet therapy at least for one month after bare metal stents (BMS) or 12 months after drug eluted stents (DES) use, and for this reason BMS is preferred during pregnancy (57)(58)(59). In dual antiplatelet therapy period, epidural anesthesia for labor is contraindicated (60). Experience in thrombolytic therapy for AMI in pregnancy is limited.…”

“…Monitoring of heart rate, blood pressure, ECG, and monitoring of rhythm, pulse oximetry, and sometimes arterial line or swan-ganz catheter if necessary, and also use of routine drugs in acute cardiac ischemia such as beta blockers, nitroglycerines, antihypertension medications and supplementary oxygen during labor will be eligible. With adequate attention and medication, good controlling of pain and reducing 2nd stage of delivery, most patients with AMI can tolerate vaginal delivery with acceptable risk, but sometimes CS is necessary in hemodynamically unstable patients (17,60).…”