Authors: Ghafoor H et al.
Cureus 18(1): e102240. DOI: 10.7759/cureus.102240
Summary
This review covers pregnancy-associated acute myocardial infarction (AMI), emphasizing that although AMI in pregnancy is uncommon, incidence has been rising alongside older maternal age and more cardiovascular risk factors. It outlines why diagnosis can be tricky (normal pregnancy symptoms overlap with cardiac symptoms) and stresses that cardiac troponins remain reliable biomarkers because they are not meaningfully elevated by normal pregnancy or labor. The authors summarize major etiologies that differ from the typical nonpregnant population, highlighting spontaneous coronary artery dissection (SCAD) as a leading cause, along with atherosclerotic coronary artery disease, coronary spasm, and thrombosis.
The paper focuses on multidisciplinary management: rapid evaluation of chest pain, ECG interpretation with awareness of normal pregnancy variants, and the role of imaging (echo, CT coronary angiography in selected cases, and coronary angiography as definitive testing when indicated). For treatment, it reviews revascularization considerations (PCI favored for STEMI/high risk; more conservative approaches often preferred in stable SCAD due to higher complication and lower success rates), and it summarizes pregnancy and lactation considerations for antiplatelet agents, anticoagulants, and other cardiac medications.
Obstetric planning is a major section: timing of delivery should be individualized based on maternal stability and gestational age, with many recommendations favoring delaying delivery at least two weeks after infarction when feasible to reduce hemodynamic stress. Mode of delivery is not one-size-fits-all; vaginal delivery with good neuraxial analgesia is often preferred when maternal status is stable, while cesarean delivery may be chosen for obstetric indications or unstable maternal conditions. The anesthesia discussion emphasizes maintaining coronary perfusion and afterload, avoiding unnecessary fluid loading in patients at risk for pulmonary edema, using vasopressors to treat neuraxial-related hypotension, and considering more gradual-onset neuraxial techniques (epidural or sequential CSE) for higher-risk cardiac lesions. Postpartum care is highlighted as a high-risk window due to large autotransfusion and cardiac output shifts, requiring close monitoring and coordinated follow-up (including cardiac rehab, medication management, depression screening, and counseling regarding future pregnancy and contraception).
Key Points
-
Pregnancy-associated AMI is rare but increasing; SCAD is a major cause, especially late pregnancy and postpartum.
-
Troponin I/T remain useful for diagnosing myocardial injury in pregnancy; ECG changes must be interpreted with pregnancy-related normal variants in mind.
-
PCI is appropriate for STEMI/high-risk presentations; stable SCAD often favors conservative management due to procedural risks.
-
Delivery planning should be individualized; when possible, delaying delivery for at least two weeks after AMI may reduce risk.
-
Neuraxial techniques are often preferred, with careful hemodynamic management and consideration of gradual-onset approaches in higher-risk patients.
-
Postpartum is a particularly high-risk period; multidisciplinary follow-up and maternal mental health screening matter.
What You Should Know
-
If a pregnant or postpartum patient has chest pain, “it’s probably just pregnancy” is a dangerous assumption—early, protocolized evaluation saves lives.
-
For anesthesia during cesarean delivery in patients with recent AMI/SCAD, the practical priorities are maintaining afterload/coronary perfusion, preventing tachycardia, and avoiding fluid overload.
-
Postpartum hemodynamic shifts can destabilize even “improving” patients—plan monitoring and escalation pathways ahead of time.
Thank you for sharing this Cureus article.