title: [Chest pain at 32 weeks' gestation: pregnancy-related spontaneous coronary artery dissection].
abstract: A 32-year-old woman at 32 weeks gestation presented with cardiac arrest due to ventricular tachycardia following acute chest pain at home. After immediate defibrillation with return of spontaneous circulation (ROSC), an ST segment elevation myocardial infarction due to coronary artery dissection was confirmed. Two drug-eluting stents were implanted and she was placed on dual antiplatelet therapy (DAPT). The echocardiogram showed akinesis of the apex and anterior wall. The patients risk for stent thrombosis was considered high and therefore DAPT was continued until cesarean section at 35 weeks gestation. Intraoperatively she received two units of packed red blood cells, one platelet concentrate, 4 g fibrinogen and 2 g tranexamic acid. Left ventricular ejection fraction deteriorated 8 days after delivery and the patient developed congestive heart failure.
authors.affiliation: Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Freiburg i. Brsg., Hugstetter Str. 55, 79106, Freiburg, Deutschland. axel.schmutz@uniklinik-freiburg.de.
authors.forename: A
authors.initials: A
authors.lastname: Schmutz
authors.affiliation: Klinik für Frauenheilkunde, Universitätsklinikum Freiburg i. Brsg., Freiburg, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Quaas
authors.affiliation: Klinik für Kardiologie und Angiologie I, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Freiburg, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Grundmann
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000209:etiology / Q000628:therapy; D002585:Cesarean Section; D002637:Chest Pain / Q000000981:diagnostic imaging / Q000209:etiology*; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents; D004452:Echocardiography; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000628:therapy*; D011256:Pregnancy Outcome; D014652:Vascular Diseases / Q000151:congenital* / Q000000981:diagnostic imaging / Q000628:therapy
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Myocardial infarction; Platelet aggregation inhibitors; Pregnancy complication; Pregnancy-associated spontaneous coronary artery dissection (P-SCAD)