Document Detail

Myocardial infarction in the 31st week of pregnancy--case report.
MedLine Citation:
PMID:  21474030     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVES: The occurrence of acute myocardial infarction (AMI) during pregnancy is rare. The authors describe the case of MI in a 31-week pregnant woman and the importance of a multidisciplinary team for its approach.
CASE REPORT: Thirty-one week pregnant woman with history of smoking, alcoholism and hypertension was admitted after an episode of syncope. On admission she was conscious and asymptomatic, although hypotensive. The electrocardiogram showed marked ST-segment elevation in D1, aVL, V1-V6. The cardiac enzymes were positive. The transthoracic echocardiogram showed reduction in septal and left ventricular contractility and an ejection fraction of 30%. Angiography revealed proximal occlusion of the left anterior descending artery. After a non-successful balloon angioplasty, a metallic stent was placed. The patient started therapy with beta-blockers, aspirin and clopidogrel. As for the delivery, we chose to perform a cesarean section four weeks after MI. Clopidogrel was suspended seven days before delivery. The preoperative cardiac function was improved by infusion of levosimendan started the day before. Cesarean section occurred under epidural block. The intraoperative period showed no complications, except for mild hypotension easily corrected with phenylephrine. The Apgar score for the newborn was 9/10.
CONCLUSIONS: This is one of the few cases of myocardial infarction and angioplasty reported during pregnancy. The authors discuss the decisions taken by the multidisciplinary team consisting of anesthesiologists, obstetricians, neonatologists and cardiologists, particularly with regard to dual antiplatelet therapy, the type of delivery and anesthesia.
Filipa Pires Duarte; Patrícia O'Neill; Maria João Centeno; Isabel Ribeiro; João Moreira
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Revista brasileira de anestesiologia     Volume:  61     ISSN:  1806-907X     ISO Abbreviation:  Rev Bras Anestesiol     Publication Date:    2011 Mar-Apr
Date Detail:
Created Date:  2011-04-08     Completed Date:  2011-08-30     Revised Date:  2014-02-05    
Medline Journal Info:
Nlm Unique ID:  0401316     Medline TA:  Rev Bras Anestesiol     Country:  Brazil    
Other Details:
Languages:  eng; por; spa     Pagination:  225-7, 228-31, 120-3     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Editora Ltda. All rights reserved.
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MeSH Terms
Myocardial Infarction / therapy*
Pregnancy Complications, Cardiovascular / therapy*
Pregnancy Trimester, Third

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