Acute cardiac syndrom and pregnancy-

Acute coronary syndrome ACS in pregnancy has traditionally been considered to be a rare event, but the combination of normal physiological changes of pregnancy and more prevalent cardiovascular risk factors are increasing its incidence in this population. The present report describes a 39 year-old woman that is seven weeks pregnant presenting with a non ST elevation myocardial infarction. The incidence, risk factors, pathophysiology and management of ACS in pregnancy are discussed. A 39 year old female who was seven weeks pregnant presented to a community hospital emergency department with a first episode of chest pain. She had a twenty pack per year smoking history and a significant family history of coronary artery disease CAD with her father developing CAD in his thirties.

Acute cardiac syndrom and pregnancy

Acute cardiac syndrom and pregnancy

Acute cardiac syndrom and pregnancy

Acute cardiac syndrom and pregnancy

Thrombolytic therapy in pregnancy. Maternal AMI must be treated prior to delivery. Sudden cardiac arrest developed while the patient was waiting Puplic xxx video the triage room. There was no prior history of connective tissue disease, vasculitis, impaired anticoagulant mechanism protein C deficiency, protein S deficiencyor antiphospholipid antibody syndrome, which are prehnancy with a thrombotic tendency. In our case, a decision was taken to use lead apron protection.

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There were no signs of congestive heart failure with Acute cardiac syndrom and pregnancy pedal edema, clear lungs, and no jugular venous distension. These 3 characteristic clinical manifestations do not occur uniformly in all patients; any component may dominate or be entirely absent. Tawnee stone fucking videos material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. They suggested that their findings identified a new Acute cardiac syndrom and pregnancy, termed maternal pulmonary embolism by amniotic fluid, characterized by shock that developed during labor or shortly after delivery. They'll give your presentations a professional, memorable appearance - the kind of sophisticated look that today's audiences expect. It was associated with intense nausea and vomiting, and she had some relief with aspirin. This article is for Medical Professionals. Placental abruption was detected, and a stillborn weighing 1, g was delivered. These signs and symptoms may commence during labor, after vaginal or cesarean delivery, or after pregnancy termination. A chest X-ray revealed no abnormalities.

The incidence of cardiac disease among pregnant women is around 0.

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  • In the United States, anaphylactoid syndrome of pregnancy, previously known as amniotic fluid embolism, is a leading cause of maternal mortality.
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Acute coronary syndrome ACS in pregnancy has traditionally been considered to be a rare event, but the combination of normal physiological changes of pregnancy and more prevalent cardiovascular risk factors are increasing its incidence in this population. The present report describes a 39 year-old woman that is seven weeks pregnant presenting with a non ST elevation myocardial infarction.

The incidence, risk factors, pathophysiology and management of ACS in pregnancy are discussed. A 39 year old female who was seven weeks pregnant presented to a community hospital emergency department with a first episode of chest pain. She had a twenty pack per year smoking history and a significant family history of coronary artery disease CAD with her father developing CAD in his thirties.

She had no known history of diabetes, dyslipidemia, or hypertension. The pain started after an episode of intense vomiting. She described the pain as a pressure sensation, retrosternal in location, with radiation down both arms. It was associated with intense nausea and vomiting, and she had some relief with aspirin.

The pain continued at a high intensity for approximately five hours. Given the duration of discomfort and associated extreme weakness she sought medical attention. In the emergency department, she denied recreational drug use, and did not have any constitutional symptoms. Clinically there was no evidence of deep vein thrombosis DVT , pulmonary embolism PE , or pericarditis.

There were no signs of congestive heart failure with no pedal edema, clear lungs, and no jugular venous distension.

The precordial exam was normal with no heaves, thrills, normal S 1 and S 2 with normal physiological splitting and no extra heart sounds, rubs or murmurs.

Initial blood work showed a significant elevation of the cardiac markers with a Troponin T of 0. Urine drug screen was negative. Twelve-lead electrocardiogram showing ST segment depression in leads V 4 and V 5. This presentation was complicated by a positive home pregnancy test. The estimated gestational age was seven weeks and six days by last menstrual period.

Her past obstetrical history included three pregnancies with one full term delivery, one preterm delivery, and one therapeutic abortion. The patient was transferred from a community hospital to our tertiary center for further management. Chest pain in pregnant women is rarely due to myocardial infarction. Pulmonary, gastrointestinal, psychiatric, neuromuskuloskeletal, along with non-ischemic cardiac causes of chest pain must be considered in these patients. The incidence of myocardial infarction in pregnancy has been estimated to be 6.

The timing of MI in pregnancy varies. With labour, myocardial ischemia may be precipitated by a further increase in myocardial oxygen demand driven by pain, uterine contraction, and anxiety. After delivery, caval compression is relieved and blood flow is shifted from the uterus back to the systemic circulation resulting in further stress on the myocardium and likely contributing to the increased incidence of myocardial infarction in the puerperium. With a compromise in the coronary blood flow, the high demand physiological state of normal pregnancy would precipitate myocardial ischemia and potentially infarction.

Rarely, vasculitic syndromes, hypercoagulable states, coronary artery spasm, increased myocardial demand, coronary emboli, congenital coronary anomalies, trauma and aneurysm may cause AMI. Pregnancy is a known hypercoagulable state. The risk factors for AMI are also commonly seen in pregnancy, including diabetes mellitus, smoking, advanced maternal age, dyslipidemia, significant family history and hypertension. It is these systemic changes in conjunction with the physiological changes of increased blood volume and cardiac output that likely result in increased shear forces that result in dissection occurring not only in single vessels, but frequently in multiple coronary arteries.

The treatment of ACS has been well established for the non-pregnant patient, but many uncertainties remain in the management of pregnant patient which may delay treatment. A classification scheme has been established to identify the associated risks with certain medications in pregnancy Table 1.

There was insufficient data to comment on perinatal mortality or preterm delivery. It is recommended that Clopidogrel be stopped 1 week prior to any regional anesthesia procedures. These drugs cannot be recommended in pregnant patients, however if they are used a C-section delivery is recommended to decrease the potential for fetal intracranial hemorrhage.

Many animal and human studies have found that ACE inhibitors and ARBs cause multiple birth defects including renal dysgenesis, oligohydramnios, IUGR, prematurity, bone malformations, limb contractures, death and multiple others.

Although laboratory models show potential placental growth disruption and animal studies have shown skeletal abnormalities and increases in mortality, a recent systematic review found that most data of human teratogenicity were only case reports and that the overall risk is likely minimal. The authors stated that statin exposure did not warrant termination of pregnancy as a sole reason. Classification for safety of medication use during pregnancy. The use of invasive catheter procedures for management of AMI in pregnancy is also not clearly identified.

Numerous case studies have been published that describe results of both invasive and conservative management. In one report a patient was managed conservatively with ASA and beta-blockers, while waiting for the post-partum period to undergo cardiac catheterization.

Other reports have described treating pregnant women with early percutaneous coronary intervention PCI and stent placement. Both reported favorable fetal and maternal outcomes. The teratogenic effects of radiation were first reported in when Goldstein and Murphy observed a high rate of micorcephaly and reduced cranial circumference in women who had undergone radiation treatment for uterine cancer during pregnancy. While many studies have shown that a fetal dose of 5 rads is not related to teratogenicity at any period of gestation, the most vulnerable time for the fetus is 8—15 weeks of gestation.

The amount of radiation that reaches the fetus is a percentage of the total amount delivered to the patient and depends on the body parts being irradiated and the type of protection used. No necessary radiodiagnostic examination that is clinically justifiable should be avoided due to pregnancy, and protective measures for the mother and fetus should be taken. Other diagnostic procedures that are equally as effective but not as dangerous to the fetus should be preferentially used.

It is important to weigh the risks and benefits of each potential therapy and tailor the management according to the clinical presentation.

The patient was started on ASA, beta-blockers, and intravenous unfractionated heparin. Nitroglycerine spray was prescribed to be used as needed for chest pain relief. The obstetrics team was consulted to guide in management.

PCI was discussed however not pursued as she had a normal left ventricular ejection fraction, no recurrent chest pain, no electrical or mechanical complications. A pelvic ultrasound showed an intrauterine pregnancy with no fetal heartbeat, consistent with fetal demise. Expectant management of the fetus was chosen and follow-up ultrasound was arranged with the obstetrics team. The cardiology team arranged follow-up regarding long term medications and planning for further risk stratification.

Although ACS in pregnancy has been historically uncommon, the increasing prevalence of atherosclerotic risk factors in women of child bearing age combined with the normal physiological changes of pregnancy will cause the incidence of this presentation to increase in clinical practice.

It is important that physicians are familiar with the clinical presentation, risk factors, potential management options and their interactions with both the pregnant female and the fetus.

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This is an open access article. Unrestricted non-commercial use is permitted provided the original work is properly cited. Abstract Acute coronary syndrome ACS in pregnancy has traditionally been considered to be a rare event, but the combination of normal physiological changes of pregnancy and more prevalent cardiovascular risk factors are increasing its incidence in this population.

Keywords: Acute coronary syndrome, pregnancy, risk factors, pathophysiology. Case Report A 39 year old female who was seven weeks pregnant presented to a community hospital emergency department with a first episode of chest pain.

Open in a separate window. Figure 1. Discussion Chest pain in pregnant women is rarely due to myocardial infarction. Category Interpretation A Controlled studies show no risk Adequate, well-controlled studies in pregnant women have failed to demonstrate risk to the fetus. B No evidence of risk in humans Either animal findings show risk but human findings do not or, if no adequate human studies have been done, animal findings are negative. C Risk cannot be ruled out Human studies are lacking and animal studies are either positive for fetal risk or lacking as well.

However, potential benefits may justify the potential risk. D Positive evidence of risk Investigational or post-marketing data show risk to fetus.

Nevertheless, potential benefits may outweigh the risk. X Contraindicated in pregnancy Studies in animals or humans, or investigational or post-marketing reports have shown fetal risk which clearly outweighs any possible benefit to the patient. Return to the Case The patient was started on ASA, beta-blockers, and intravenous unfractionated heparin.

Disclosures The authors report no conflicts of interest. References 1. Acute myocardial infarction in pregnancy: a United States population-based study.

Roth A, Elkayam U. Acute myocardial infarction associated with pregnancy. J Am Coll Cardiol. Myocardial infarction during pregnancy: a review. Obstet Gynecol. Acute myocardial infarction in pregnancy and the puerperium: a population-based study. Badui E, Enciso R.

Acute myocardial infarction during pregnancy and puerperium: a review. Drugs in Pregnancy and Lactation. Current Obstetrics and Gynecologic Diagnosis and Treatment. Philadelphia: McGraw-Hill;

Urine drug screen was negative. Arch Fam Med. Oxygen therapy, pain management, and intravenous fluids were provided. Central hemodynamic alterations in amniotic fluid embolism. Although analysis of arterial blood from the umbilical cords of 11 neonates in the national registry study 3 revealed a mean pH of 6. Women, older patients, and patients with diabetes are often found to have acute coronary syndrome without experiencing chest pain or discomfort.

Acute cardiac syndrom and pregnancy

Acute cardiac syndrom and pregnancy

Acute cardiac syndrom and pregnancy

Acute cardiac syndrom and pregnancy. WHAT YOU NEED TO KNOW:

Oxygen therapy, pain management, and intravenous fluids were provided. The laboratory tests showed hemoglobin electrophoresis of S Her heart sounds were normal, and pulmonary sounds were reduced on lung bases bilaterally. Broad-spectrum antibiotics were administered. A chest X-ray revealed no abnormalities.

Cardiotocography showed fetal tachycardia and repeated late decelerations. Fetal distress was diagnosed. At this time, the maternal hemoglobin level was 6. Two packs of red blood cells were transfused prior to the emergency cesarean. A small-for-gestational-age male infant was born, weighing 2, g, with Apgar scores of 1, 6, and 8 at 1, 5, and 10 minutes, respectively. After the cesarean, the patient was transferred to the ICU and received 3 more units of red blood cell concentrate.

She was discharged from the hospital 10 days postpartum, and the newborn was alive and well. ACS is an important cause of maternal morbidity and mortality, leading to hospital admission of pregnant women with SCD. Aggressive treatment and red blood cells transfusions should be instituted before childbirth in order to prevent an adverse outcome for both mother and infant. Maternal acute hypoxemia leads to fetal distress and adverse perinatal outcome.

During pregnancy, ACS has been described as presenting favorable maternal and neonatal outcomes. Treatment would require the use of antibiotics, oxygen therapy, pain control, administration of IV fluids, and red blood cell transfusion or exchange transfusion. The decision-making process with regard to the use of red blood cell or an exchange transfusion should be based upon the severity of maternal and fetal compromise.

An early red blood cell transfusion may increase the oxygen-carrying capacity and improve pulmonary function in pregnant patients with ACS prior to cesarean delivery. Female patients with SC disease may present with complications at any time over the course of the pregnancy, labor and delivery, or post-partum.

Prompt recognition of severe respiratory failure is required to provide the intensive treatment needed to improve maternal-fetal outcomes. Obstetricians must work closely with hematologists in order to prevent maternal death in cases of ACS during pregnancy. National Center for Biotechnology Information , U. Journal List Clinics Sao Paulo v. Clinics Sao Paulo. Author information Copyright and License information Disclaimer.

This article has been cited by other articles in PMC. The results of laboratory tests provide useful information that can be used to guide therapy.

Elevated serum levels of lactate signal disturbances in cellular oxygenation. Laboratory abnormalities associated with coagulopathy include a prolonged partial thromboplastin time, prolonged prothrombin time, elevated levels of fibrin-fibrinogen degradation products, decreased hemoglobin level and hematocrit, thrombocytopenia, and depleted fibrinogen levels. Patients with signs and symptoms of anaphylactoid syndrome of pregnancy require immediate treatment.

Therapies are supportive, because no specific therapies consistently improve outcomes for these women. Physicians, nurses, medical technicians, and respiratory therapy technicians must rapidly initiate cardiopulmonary resuscitation and Advanced Cardiac Life Support protocols for patients with cardiopulmonary arrest. The healthcare team should monitor results of pulse oximetry, arterial blood gases, and end-tidal carbon dioxide values and adjust oxygen and ventilator therapies as indicated.

Progesterone promotes a respiratory alkalosis with compensatory metabolic acidosis and a PaCO 2 of 28 to 32 mm Hg, a mean pH of 7. A PaCO 2 greater than 32 to 34 mm Hg indicates hypoventilation. Nursing measures to maintain cardiac output, blood pressure, cerebral blood flow, and kidney perfusion include the rapid administration of crystalloid solutions through a large-bore intravenous or central venous catheter.

It is important to remember that these patients have a profound vascular leak. Because patients often require massive volumes of blood products to correct the coagulopathy and anemia due to ongoing hemorrhage, interstitial fluid overload can easily develop. As soon as blood products are available, crystalloid fluids should be used judiciously.

Before delivery, the patient should be positioned on her side to maximize venous return. The skin should be assessed continually for color, temperature, and moisture. Nurses often administer and adjust doses of vasopressors and inotropic agents to treat hypotension and heart failure.

Physicians and nurses routinely use hemodynamic monitoring data such as mixed venous oxygen saturation, cardiac output or index, pulmonary capillary wedge pressure, and central venous pressure to guide management. Target ranges for hemodynamic variables for patients with anaphylactoid syndrome of pregnancy.

Nursing actions to treat coagulopathy and hemorrhage include the administration of packed red blood cells, platelets, fresh-frozen plasma, and cryoprecipitate as soon as these become available.

Whole blood would be ideal; however, most institutions do not stock whole blood. If profound hemorrhage occurs, nurses must transfuse O-negative packed cells so that the transfusion is not delayed by waiting for type-specific and crossmatched blood.

Use of a rapid volume infuser facilitates administration of massive amounts of fluids and blood products. Although controversial, low-dose heparin is sometimes used to inhibit the coagulation cascade and thus treat consumptive coagulopathy.

Nurses should anticipate and prevent hypothermia, hyperkalemia, hypocalcemia, citrate intoxication, fever, hypersensitivity reactions, and tachycardia because these may be associated with largevolume blood transfusions. However, as with other specific therapies, because of the rarity of the syndrome, prospective evaluation of various treatment strategies is unlikely. Hypothermia may produce coagulopathy, thrombocytopenia, dysrhythmias, peripheral tissue ischemia, altered mentation, and increased hemoglobin affinity for oxygen.

After the patient is in stable condition and transfers out of the ICU, the goals will be for her to perform self-care, demonstrate safe infant care, and prepare for discharge.

Nursing interventions for patients with anaphylactoid syndrome of pregnancy. Our patient was a year-old primigravida at 39 weeks 1 day gestational age who underwent a low forceps vaginal delivery because of fetal bradycardia.

A laceration of the left vaginal sidewall in combination with uterine atony resulted in an estimated blood loss of mL. Approximately 30 minutes after the delivery of the infant and at the completion of the repair, the patient had sudden cardiopulmonary failure. The presumptive diagnosis was anaphylactoid syndrome of pregnancy.

Resuscitative measures were initiated. The patient was intubated, multiple intravenous catheters were placed, and crystalloid boluses were begun pending the arrival of blood products. Despite normal uterine tone, the patient continued to hemorrhage. Blood was evident in the Foley catheter, and large hematomas developed at the insertion sites of the central and peripheral catheters. After the initial resuscitation, volume replacement was accomplished by using mostly blood products.

Crystalloid fluids were limited because of the anticipated need for a massive transfusion of blood products and concern for potential fluid overload.

After 10 hours of treatment, her condition had stabilized to the point that she could be transferred to the ICU. Six hours after the initial event, she had become anuric and soon after arrival in the ICU, an echocardiogram revealed significant cardiac contractility dysfunction.

Inotropic agents were initiated, but only minimal improvement in hemodynamic parameters occurred. Nonetheless, because of persistent heavy bleeding, she continued to require large volumes of blood products to replace red blood cells and coagulation factors.

Because of the nonfunctioning kidneys, we elected to initiate hemodialysis to help remove the excess fluid. Within 30 minutes after hemodialysis was started, cardiopulmonary function rapidly improved and inotropic agents were discontinued.

During the first 21 hours after delivery, the patient received more than L of fluids, including 10 L of crystalloid fluids, 53 units of packed red blood cells, 56 units of fresh-frozen plasma, 4 units of cryoprecipitate, and 7 sixpacks of platelets.

During the next 36 hours, the patient continued to receive blood products to correct the coagulopathy final total was 80 units of packed red blood cells, 71 units of freshfrozen plasma, and 20 six-packs of platelets, exposing the patient to more than blood donors. Hemodialysis was continued for the next week to maintain her fluid balance and possibly remove pathological proinflammatory mediators. Her pulmonary function remained good throughout the process, with only mild acute respiratory distress syndrome.

Dilatation and curettage was performed in the ICU to evacuate large amounts of uterine clots. The patient was transferred from the ICU on postpartum day 12 and discharged home on day Panhypopituitarism was diagnosed. We attributed this abnormality to hypotension-induced pituitary necrosis Sheehan syndrome.

The physiological pituitary hypertrophy that normally accompanies pregnancy leaves the pituitary gland susceptible to hypotension-induced injury.

The patient also had vaginal reconstructive surgery but otherwise survived this catastrophic event without detectable renal, cardiac, pulmonary, or neurological impairment.

We attribute this successful outcome to a patient-centered and multidisciplinary care approach, advanced clinical skills, flexible scheduling, open communication among caregivers, and coordination with the US Navy. Two Navy ships made unscheduled port visits so that sailors could donate blood. Additional Navy-sponsored blood drives ensured that we maintained an adequate blood reserve. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Air Force or the Department of Defense.

User Name Password Sign In. Merlin B. Previous Section Next Section. View larger version: In this window In a new window. View this table: In this window In a new window. Table 1 Maternal signs and symptoms of anaphylactoid syndrome of pregnancy. Table 2 Differential diagnoses for patients with anaphylactoid syndrome of pregnancy 2, 12, Table 3 Target ranges for hemodynamic variables for patients with anaphylactoid syndrome of pregnancy.

Table 4 Nursing interventions for patients with anaphylactoid syndrome of pregnancy. Previous Section. Pregnancy-related mortality surveillance: United States, — Google Scholar. Martin RW. Amniotic fluid embolism. Clin Obstet Gynecol. Medline Google Scholar. Amniotic fluid embolism: analysis of the national registry.

Am J Obstet Gynecol. CrossRef Medline Google Scholar. Gilbert WM , Danielsen B. Amniotic fluid embolism: decreased mortality in a population-based study. Obstet Gynecol. Green BT , Umana E. South Med J.

The incidence of cardiac disease among pregnant women is around 0. Cardiac disease is the main cause of mortality among parturint in developed countries, and it remains the worst cause of all indirect maternal deaths. Acute myocardial infarction AMI in women of reproductive age 16 — 45 years of age is a rare event. During pregnancy, the risk of AMI is increased three to four fold, compared to non-pregnant women.

Incidence of AMI has been reported to be between , to , deliveries. This incidence is likely to increase due to a continuing trend of childbirth in older women, the use of reproductive technologies that allow older and postmenopausal women to conceive, the increased use of oral contraceptives in women over 35 years of age, and substance abuse during pregnancy especially cocaine. AMI during pregnancy or immediate post partum period is associated with a higher maternal and fetal mortality.

Outcome is better during early pregnancy. Improvement in survival might be related to improved strategies for identifying and treating ACS, including rapid thrombolysis and percutaneous interventions PCI. As an example, the risk for AMI during pregnancy is 30 fold higher in women over 40 compared with those less than 20 years of age.

Obstetric risk factors for AMI include preeclampsia, postpartum infection, postpartum hemorrhage, and the requirement of a blood transfusion. Acute coronary syndrome ACS is a term used in patients when there is clinical suspicion of myocardial ischemia. The diagnosis of AMI is the same among parturient as in non-pregnant patients, and is made based on history, physical findings, ECG changes, and cardiac markers.

Normal changes during pregnancy as well as fetal safety influence some of the diagnostic criteria and approaches. Among non pregnant patients, the most significant symptoms include chest pain, dyspnea, diaphoresis, poor exercise tolerance, and syncope. It is important to note that all of these symptoms may occur in normal pregnant patients without MI, which sometimes can delay the diagnosis of AMI. ECG and enzyme values remain the gold standard in diagnosis.

ECG changes may not be as reliable and may mimic ischemia even in normal parturients. It is important to remember that even during a normal pregnancy, the ECG may show sinus tachycardia, a leftward shift, ST-segment depression, flattened or inverted T waves, and a Q wave in lead III.

Because these changes can be seen during a normal pregnancy, serial ECG changes are more meaningful than isolated ECG changes. Measurement of the plasma troponin-1 level is useful in patients with suspected peripartum myocardial infarction because these levels remain within the normal range unless myocardial injury has occurred. The serum CK-MB fraction may increase two fold 30 minutes after delivery in the absence of myocardial ischemia.

Holter monitoring and echocardiography ECHO are noninvasive, useful, and safe evaluations during pregnancy. While Holter monitoring may not be completely reliable, ECHO can evaluate for the presence of any wall-motion abnormalities.

Chest pain should never be ignored, and if the chest pain is significant, cardiac consult should be requested. Maternal AMI must be treated prior to delivery. The maternal risk associated with delivery without treating ACS is very high.

Mode of delivery should optimize the maternal clinical status and obstetric consideration for the fetus. Cardiac consult is of utmost importance, and close multispecialty management is mandatory. Treatment should be directed towards relief of ischemic pain, hemodynamic stability, initiation of reperfusion therapy with primary percutaneous coronary intervention PCI or fibrinolysis, and antithrombotic therapy and beta blocker therapy to prevent life threatening ventricular arrhythmias and recurrent ischemia.

The pharmacologic agents e. Treatment of myocardial ischemia while maintaining cardiac output improves cardiac function, which should increase the uteroplacental perfusion. Follow the MONA protocol morphine, oxygen, nitroglycerine, and aspirin while awaiting an expert opinion. Conversely, an overly aggressive therapy may adversely affect the fetus.

For example, intravenous nitroglycerin or morphine can result in a sudden reduction in preload, which may reduce maternal cardiac output and uteroplacental prefusion. Other associated diseases which may adversely reduce myocardial oxygen supply e. It is prudent to monitor the fetal heart rate FHR in these patients. Urgent PCI is the treatment of choice. Bare metal stents are usually preferred over drug-coated drug eluting — DES stents. DES stents require prolonged prophylactic clopidrogel to avoid thrombosis during delivery and have to be discontinued to avoid major bleeding during delivery.

The fetal radiation dose from PCI is low. Appropriate lead shielding is mandatory for fetal protection, so the maternal back and the abdomen should be protected appropriately and the field size coned down to the area of interest. Cardiac catheterization and interventional procedures are associated with a fetal radiation exposure of up to 0. In general, as long as the organogenesis is complete, this level of exposure should not alter maternal management if catheterization is indicated.

There is an increased risk to the fetus of dying of cancer within 15 years, which for a 60 minute screening in the antero-posterior AP projection, is estimated at , As for all procedures that require a pregnant woman to lie prone, a wedge should be placed under the right hip to prevent uterine compression of the inferior vena cava.

Continuous ECG and SpO2 during labor or cesarean section and invasive monitoring, such as intra-arterial catheter and pulmonary artery catheter, should be considered in patients with either MI or ventricular or valvular dysfunction. Prevent hypocapnia and catecholamines, as they produce coronary artery vasoconstriction. Avoid pain and hyperventilation. Prevent sudden hypotension, which may reduce coronary perfusion. Prevent hypertension and tachycardia, as they increase myocardial oxygen demand.

Remember some drugs can cause coronary steal. In patients with ACS secondary to cocaine abuse, it is important to administer benzodiazepines early during treatment and to avoid using beta blockers due to the possible exacerbation of coronary vasoconstriction. Avoid methylergonovine during the third stage of labor because it can precipitate coronary artery spasm. Congestive heart failure, coronary dissection, maternal collapse, and fetal demise are complications of AMI. Coronary dissection and irradiation to the fetus are complications from PCI.

Placental abruption can occur from t-PA treatment. Severity of the underlying condition precipitating the MI and the myocaridal function correlate with outcome for these patients.

Timing of the event in relation to pregnancy and delivery also plays an important role in fetal and maternal outcomes. AMI during labor and the third trimester are associated with higher mortality. MI with refractory congestive heart failure during pregnancy has worse outcomes for the mother and fetus, and early cesarean delivery should be undertaken.

Vaginal delivery is preferred over cesarean section in patients where AMI occurred prior to the peripartum period. Vaginal delivery should be undertaken with a dense epidural block to prevent an increase in cathecholamines and pain during delivery. Sympathectomy associated with epidural block reduces preload as well as afterload, thereby reducing oxygen demand. Cesarean delivery should be considered mainly for obstetric indications.

Epidural is the anesthetic of choice, which can also be used for postoperative pain management. Roth, A, Elkayam, U. J Am Coll Cardiol.. Review article on MI in pregnancy with treatment alternatives. Expert Rev Cardiovasc Ther.. Review article of ACS in pregnancy, includes review of case reports in literature. J Am Coll Cardiol. All rights reserved. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC.

Login Register. What every clinician should know The incidence of cardiac disease among pregnant women is around 0. Powered By Decision Support in Medicine. What every clinician should know 2. Diagnosis and differential diagnosis 3. Management Prepartum Intrapartum Postpartum 4. Complications 5. Prognosis and outcome 6. What is the evidence for specific management and treatment recommendations. Popular Emailed Recent Loading Please login or register first to view this content.

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Acute cardiac syndrom and pregnancy