MYOCARDIAL-INFARCTION DURING PREGNANCY - MANAGEMENT AND OUTCOME OF 2 PREGNANCIES

OBJECTIVE: Each year in the United States approximately 500,000 women die from ischemic heart disease. However, there are < 100 reported cas es of myocardial infarction occurring during pregnancy. The current ma nagement of these patients is empiric, with pulmonary artery catheteri zation during labor being frequently reported. STUDY DESIGN: In the pa st year we have managed and delivered two such patients, including the first reported case of myocardial infarction with a triplet gestation . RESULTS: Both patients had clinical and laboratory signs of myocardi al infarction and underwent coronary angiography. They subsequently ha d preeclampsia and were prematurely delivered of viable fetuses. One p atient had angina pectoris during labor and was successfully treated w ith sublingual nitroglycerin. Neither patient suffered reinfarction or heart failure. Invasive hemodynamic monitoring was not used, and the mode of delivery was determined solely on obstetric indications. CONCL USION: In pregnant patients with myocardial infarction, invasive centr al monitoring is unnecessary in patients with good cardiac function an d reserve and the mode of delivery should be based on obstetric indica tions.