1. Coronary artery vasospasm induced acute myocardial infarction in pregnancy: a new case and systematic review of the literature
- Author
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Alexandra Ward, Ankita Kulkarni, Gregary D. Marhefka, Pamela Parker, Hannah B. Anastasio, Adi Hirshberg, Vincenzo Berghella, and Janelle Santos
- Subjects
Embryology ,medicine.medical_specialty ,Pregnancy ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,030204 cardiovascular system & hematology ,Coronary angiogram ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Coronary Artery Vasospasm ,Internal medicine ,Coronary vasospasm ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,Myocardial infarction ,business - Abstract
Background Acute myocardial infarction (AMI) in pregnancy is a rare event and of the causes, coronary artery vasospasm (CAV) is considered even more uncommon. Purpose We present a new case report of a woman at 32 weeks of pregnancy with an AMI from CAV with a normal coronary angiogram. We performed a systematic review of similar cases of spontaneous AMI related to CAV to better understand its characteristics and management. AMI was defined as elevated cardiac enzymes (troponin or CKMB) with chest pain and/or electrocardiogram (EKG) changes consistent with ischemia. Methods We use the terms “acute myocardial infarction”, “myocardial infarction”, “coronary artery vasospasm” and “pregnancy” for our PubMed review. We also evaluated all references in identified manuscripts. Six cases of AMI in pregnancy due to CAV have been reported as of November 2016, including ours. Results and conclusion Six cases of AMI due to CAV during pregnancy or postpartum are reported in the literature, including ours. Patients experiencing this condition tend to be of advanced maternal age, multigravida and in their third trimester or postpartum. Successful management with a combination of long acting nitrates and/or calcium channel blockers achieved symptomatic control in all published cases. Obstetric outcomes were mostly normal, with the majority experiencing uncomplicated deliveries at term.
- Published
- 2018