Acute myocardial infarction and pregnancy

Pregnancy-associated acute myocardial infarction (PAMI) can have catastrophic results and accounts for a considerable proportion of cardiovascular-related mortality in pregnancy. The pathophysiology behind PAMI is complex and multifactorial and depends on the specific coronary abnormality inducing it. The diagnosis of PAMI may represent a challenge and a critical determinant in the outcome of patients with this condition and accordingly requires a high degree of vigilance. The treatment plan of women with PAMI should consider the unique characteristics of this condition and the special considerations of potential maternal and fetal effects. Recent recommendations for drug therapy in the nonpregnant patient with AMI include the potential use of several drugs, including morphine sulfate; β-blockers; nitroglycerin; calcium channel blockers; heparin and its derivatives; and antiplatelet therapy including aspirin. Clinical deterioration required mechanical support in 28% of the patients with PAMI due to spontaneous coronary artery dissections.