ACUTE MYOCARDIAL-INFARCTION DURING PREGNANCY AND PUERPERIUM REVIEW

The purpose of this review is to analyze the possible parameters that lead to the development of what is a rare event-acute myocardial infar ction (AMI) during pregnancy and puerperium. Through the Index Medicus , 109 publications on the subject were obtained. Since the first well- documented case by Katz in 1922, 136 patients have been reported, and from these reports the following data have been gathered: the average age was 32.1 years. This event is more frequent during the third trime ster and puerperium of the first and second pregnancies. In 42.6% of t he patients no coronary risk factors were observed, but when present, hypertension and cigarette smoking were the most common. The anterior wall along or in combination with any other anatomic area was affected in 73% of cases. Coronary angiograms, when taken, appeared normal in 47%. The maternal mortality rate was 26/136 (19.1%) and was higher dur ing the third trimester, labor, and puerperium. Eight patients (8/26) (30.7%) had sudden death. In 5 of these, (62.5%) coronary thrombosis w as found. In 18/26 deaths, an autopsy was performed; 9/18 (50%) had co ronary thrombus formation and in 7/18 (39%) variable degrees of athero sclerosis were detected. On the other hand, the fetal mortality rate w as 16.9%; however, in only 52% was death coincidental with that of the mother. Coronary artery spasm associated with a probable hypercoagula bility state was the most likely mechanism in the majority of these pa tients, followed by atherosclerotic heart disease and coronary dissect ion-the last being secondary most likely to hormonal changes. During t he AMI these patients should be studied by a medical team composed of a cardiologist, gynecologist, and anesthesiologist. A complete cardiol ogic work-up should be made to decide individually about further pregn ancies.