The pregnant heart: cardiac emergencies during pregnancy

Cardiovascular emergencies and cardiac arrest in a pregnant woman

“…Spontaneous coronary artery dissection is more common in pregnancy [71][72][73][74]. Coronary spasm due to prostaglandin has been reported.…”

“…The diagnosis of AMI must be considered in all patients with chest pain, dyspnoea, pulmonary oedema, ventricular arrhythmia or hypokinesia, collapsus or electrocardiogram ST changes. Creatine kinase-MB can be elevated after delivery [71]. Coronary angiography confirms the diagnosis of AMI and permits interventional procedures [75].…”

“…Delivery should be postponed at least 2 weeks after AMI. Caesarean section should not be considered as a better alternative than vaginal delivery managed with adequate pain control, supplemental oxygen, left lateral decubitus position and instrumental support [8,71].…”

“…Because drugeluting stents require prolonged dual antiplatelet therapy, bare-metal stents may also be preferred. Coronary artery bypass graft surgery is often required, with a higher risk of mortality [8,71].…”

Authors' response to “Peripartum cardiomyopathy in the ED”

“…

We thank the writers of the correspondence regarding the recently published review article "The pregnancy heart: cardiac emergencies during pregnancy" for their interest and comments [1]. The main purpose of this article was to summarize diagnostic and clinical management recommendations essential for acute care clinicians to consider for 3 common cardiovascular emergencies in the pregnant patient: peripartum/postpartum cardiomyopathy (PPCM), acute myocardial infarction, and cardiac resuscitation.

Your comments are directed toward the use of the classic definition of PPCM as described by Demakis et al [2] as left ventricle systolic dysfunction during the last month of pregnancy and the first 5 months after delivery.

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