Asymptomatic coronary artery disease in a pregnant patient. A case report and review of literature.
BACKGROUND
Acute myocardial infarction during pregnancy has been reported and has been shown to be associated with poor maternal and fetal outcomes. However, the vast majority of these patients do not have previously recognized ischemic heart disease. Pregnancy and delivery pose significant cardiac stress and risk to the mother and fetus. However, it is unknown how available therapies can be utilized in the pregnant patient with identified ischemic heart disease to minimize these risks.


METHODS
We present a 39-year-old asymptomatic diabetic female with a positive stress echocardiogram at 16 weeks of pregnancy who remained asymptomatic throughout pregnancy with medical management and went on to have a normal vaginal delivery in the process suffering a small non-ST elevation myocardial infarction with pulmonary edema following delivery due to volume overload. She ultimately underwent cardiac catheterization and successful four-vessel CABG 1 months after her delivery.


CONCLUSIONS
We present this patient to suggest a successful strategy of managing a patient with non-revascularized asymptomatic coronary artery disease during pregnancy. In addition to reviewing the appropriate medical therapy during pregnancy, we discuss the data on revascularization procedures as well as recommendations for delivery and stress testing for such patients.
Collins
J Stewart
JS
Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, USA.
Bossone
Eduardo
E
Eagle
Kim A
KA
Mehta
Rajendra H
RH
D000328:Adult; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003922:Diabetes Mellitus, Type 1 / Q000000981:diagnostic imaging / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000628:therapy*; D025401:Echocardiography, Stress; D005113:Extraction, Obstetrical; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D006801:Humans; D007231:Infant, Newborn; D009203:Myocardial Infarction / Q000628:therapy; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000628:therapy*; D011254:Pregnancy in Diabetics / Q000000981:diagnostic imaging / Q000628:therapy*; D011644:Puerperal Disorders / Q000628:therapy