Acute myocardial infarction and pregnancy

Peripartum acute myocardial infarction has been reported at any stage of pregnancy and at ages between 16 to 45. The highest incidence, however, occurs in the third trimester and in women older than 33 years. In addition, acute myocardial infarction has been noted to occur more commonly in multigravidas and its location to be more commonly in the anterolateral wall.
Most maternal death occurred either at the time of infarction or within 2 weeks. To reduce the risk of acute myocardial infarction, oral contraceptives should be avoided or formulations with lower effective doses of estrogen should be used in cigarette smokers and in women with hypertension.

Although atherosclerotic disease seems to be the primary cause of acute myocardial infarction [1] peripartum acute myocardial infarction is often associated with normal coronary angiograms and has been suggested as being due to a decrease in coronary perfusion caused by spasm or in situ thrombosis.
Although the presence of spasm has not been documented and its cause is not clear. It has been suggested as a cause of myocardial infarction in some instances with pregnancy-induced hypertension and with the administration of argot derivates, bromocriptine [2], oxytocin, and prostaglandin [3] used to suppress lactation or uterine bleeding and in patients with pheocromocytoma.

Coronary arterial dissection mostly in the immediate postpartum period has been commonly associated with peripartum acute myocardial infarction.
The dissection involves the left anterior descending artery in approximately 80 percent of cases and the right coronary artery in most other cases. Other potential causes of acute myocardial infarction during pregnancy have been collagen vascular disease, Kawasaki disease, sickle cell anemia, and hemostatic abnormalities.

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