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AJP Rep 2016; 06(03): e283-e286
DOI: 10.1055/s-0036-1587321
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Acute Myocardial Infarction in the First Trimester of Pregnancy in a Great Grand Multiparous Woman with Poorly Controlled Chronic Hypertension

Lakha Prasannan
1   Department of Obstetrics and Gynecology, Hofstra Northwell School of Medicine, Long Island Jewish Medical Center, Hempstead, New York
,
Matthew J. Blitz
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hofstra Northwell School of Medicine, North Shore University Hospital, Manhasset, New York
,
Jill M. Rabin
1   Department of Obstetrics and Gynecology, Hofstra Northwell School of Medicine, Long Island Jewish Medical Center, Hempstead, New York
› Author Affiliations
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Publication History

31 March 2016

01 July 2016

Publication Date:
16 August 2016 (online)

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Abstract

Introduction Acute myocardial infarction (MI) in pregnancy is a rare event, usually occurring late in gestation, either in the third trimester or in the puerperium. It is associated with significant maternal and fetal morbidity and mortality. Although diagnosis and management of MI in pregnancy has been discussed in the literature, management of pregnancy following an early antepartum MI, which may have more consequences for the fetus, has not received as much attention.

Case A 38-year-old great grand multiparous woman presented to the emergency department complaining of acute onset chest pain. The patient had a history of chronic hypertension and was an active smoker. She was incidentally found to be 5 weeks pregnant. She was diagnosed with an acute MI, which was treated by primary percutaneous coronary intervention. Her subsequent pregnancy course was complicated by poorly controlled chronic hypertension, but she ultimately delivered a healthy newborn at 36 weeks of gestational age.

Conclusion Good pregnancy outcomes are possible after early antepartum MI, especially with early diagnosis, appropriate treatment, and a multidisciplinary team approach to prenatal care. Delivery should occur in a tertiary referral center with experience managing high-risk obstetric patients with cardiac disease.

Keywords

myocardial infarction - hypertension - pregnancy - multiparity - advanced maternal age - smoking