A pregnant patient with extensive myocardial infarction: a case report

The incidence of myocardial infarction (MI) during pregnancy is 6 cases per 100000 births which occur more commonly at third trimester. Its maternal morbidity is 19-37% and fetal mortality is 9-13%. Anterior wall is the most common location of myocardial infraction (78%). The risk factors for myocardial infarction during pregnancy included: maternal age >35 year, hypertension, diabetes, smoking, preeclampsia, infections, and thrombophilia. On the other hand, pregnancy is a predisposing factor for coronary artery dissection. In this study, a case of myocardial infarction during pregnancy was reported.
Case report: The patient was a 37 year old pregnant woman with second pregnancy who was admitted with diagnosis of acute anterior ST elevation Myocardial infarction at 37th weeks of gestation. She had received fibrinolytic agent. After performing angiography in referral center, regarding to that the lesion was thrombotic and with good distal run off, antiplatelet and anticoagulant agents was administrated for her. After 12 hours, active labor started, probably because of retroplacental bleeding, and vaginal delivery was performed. With some days delay, percutaneous coronary intervention (PCI) was done on the dissected lesion of Left anterior descending artery by using of drug-eluting stent (DES). After 50 days, implantable cardioverter-defibrillator (ICD) was implanted for her because of low left ventricular systolic function.
If myocardial infarction occurs in pregnancy, invasive approach (angiography and Coronary stenting and then, continuing the antiplatelet agent is best choice for re-run off. In this patient, according to the angiography result, some thrombosis in LAD artery with good distal run off, antiplatelet and anticoagulant agents were administrated for her and after some days delay, angioplasty was done. If acute myocardial infarction occurs in the center without the procedures of invasive intervention, if the mother's life is threatened, at first, fibrinolytic should be used and then, invasive intervention be performed.