Acute Myocardial Infarction Due to Spontaneous Coronary Artery Dissection at 36 Weeks of Pregnancy: A Case Report

Abstract

AIM: Acute myocardial infarction in pregnancy (pAMI) is a rare event that is often caused by non-classical factors rather than atherosclerosis. The management of such complications requires a multidisciplinary team, and it is important to bring together the specialties involved to ensure that these teams are coordinated and ready to respond. The management of pAMI poses unique challenges because it requires consideration of both maternal and fetal well-being.

CASE PRESENTATION: We present the case of a 36-week pregnant woman who presented with anterolateral ST elevation myocardial infarction (STEMI) complicated by cardiogenic shock. To ensure comprehensive decision making, an emergency Pregnancy Heart Team meeting was convened, which comprised interventional cardiologists, gynecologists, and anesthesiologists. The team prioritized interventional treatment for pAMI, according to European Society of Cardiology (ESC) guidelines, and opted for primary percutaneous coronary intervention (PCI) due to the unstable maternal condition.

RESULTS: The patient underwent primary PCI as the chosen intervention for pAMI. A rapid response gynecology team closely monitored the procedure and was prepared to intervene in case of irreversible hemodynamic compromise leading to cardiac arrest. An emergency cesarean section was deemed necessary if cardiac activity was not restored within 4 minutes.

CONCLUSIONS: Managing pAMI requires a multidisciplinary approach that balances the maternal and fetal well-being. In this particular case, the Pregnancy Heart Team decided to prioritize interventional treatment with primary PCI due to the unstable maternal condition. The presence of a closely monitored gynecology team ensured prompt action in case of complications.