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Postpartum coronary vasospasm with literature review.

Koneru J, Cholankeril M, Patel K, Alattar F, Alqaqa A, Virk H, Shamoon F, Bikkina M - Case Rep Cardiol (2014)

Bottom Line: Acute myocardial infarction during pregnancy or the postpartum period is rare.We report a case of a 39-year-old postpartum woman who developed non-ST-elevation myocardial infarction due to severe diffuse coronary vasospasm.To our knowledge, this is the first case of angiographically evidenced coronary vasospasm, in a postpartum woman, with resistance to intracoronary nitroglycerin.

View Article: PubMed Central - PubMed

Affiliation: Seton Hall Cardiology Fellowship Program, St. Joseph's Medical Center, Paterson, NJ 07503, USA.

ABSTRACT
Acute myocardial infarction during pregnancy or the postpartum period is rare. We report a case of a 39-year-old postpartum woman who developed non-ST-elevation myocardial infarction due to severe diffuse coronary vasospasm. To our knowledge, this is the first case of angiographically evidenced coronary vasospasm, in a postpartum woman, with resistance to intracoronary nitroglycerin.

No MeSH data available.


Related in: MedlinePlus

(a) Normal RCA is observed. (b) Normal LAD and left circumflex arteries are observed. (c) Normal LAD is observed.
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fig3: (a) Normal RCA is observed. (b) Normal LAD and left circumflex arteries are observed. (c) Normal LAD is observed.

Mentions: The differential pathophysiology was debated by the admitting cardiologist, and due to the postpartum period, the potential diagnosis included coronary dissection, atherosclerotic plaque rupture, and Takotsubo cardiomyopathy in the postpartum period. Patient was started on aspirin, plavix, statin, lovenox, and nitrates. A 2D echocardiogram and serial EKGs were ordered. The 2D echocardiogram was reported as mildly reduced left ventricular systolic function of 45% with severe inferior and inferolateral hypokinetic regional wall motion abnormality. Thereafter, the patient underwent cardiac catheterization the subsequent day (Figures 2(a), 2(b), and 2(c)). Based on catheterization, which showed severe triple vessel diseases even after delivering eight intracoronary injections of nitroglycerine at 50 mcg each, the interventionalist decided to perform FFR of the midleft anterior descending (LAD) artery lesion which showed 0.78, without adenosine injection. It was concluded at this juncture that a second opinion was warranted regarding percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) especially with small caliber vessels and right coronary artery (RCA) likely being the culprit for the symptoms with normal TIMI 3 Flow. Patient opted for PCI and was scheduled after the postpartum period (two months later) to decrease risk of bleeding from antiplatelets given for PCI. The second catheterization (Figures 3(a), 3(b), and 3(c)) showed normal coronaries.


Postpartum coronary vasospasm with literature review.

Koneru J, Cholankeril M, Patel K, Alattar F, Alqaqa A, Virk H, Shamoon F, Bikkina M - Case Rep Cardiol (2014)

(a) Normal RCA is observed. (b) Normal LAD and left circumflex arteries are observed. (c) Normal LAD is observed.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4109216&req=5

fig3: (a) Normal RCA is observed. (b) Normal LAD and left circumflex arteries are observed. (c) Normal LAD is observed.
Mentions: The differential pathophysiology was debated by the admitting cardiologist, and due to the postpartum period, the potential diagnosis included coronary dissection, atherosclerotic plaque rupture, and Takotsubo cardiomyopathy in the postpartum period. Patient was started on aspirin, plavix, statin, lovenox, and nitrates. A 2D echocardiogram and serial EKGs were ordered. The 2D echocardiogram was reported as mildly reduced left ventricular systolic function of 45% with severe inferior and inferolateral hypokinetic regional wall motion abnormality. Thereafter, the patient underwent cardiac catheterization the subsequent day (Figures 2(a), 2(b), and 2(c)). Based on catheterization, which showed severe triple vessel diseases even after delivering eight intracoronary injections of nitroglycerine at 50 mcg each, the interventionalist decided to perform FFR of the midleft anterior descending (LAD) artery lesion which showed 0.78, without adenosine injection. It was concluded at this juncture that a second opinion was warranted regarding percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) especially with small caliber vessels and right coronary artery (RCA) likely being the culprit for the symptoms with normal TIMI 3 Flow. Patient opted for PCI and was scheduled after the postpartum period (two months later) to decrease risk of bleeding from antiplatelets given for PCI. The second catheterization (Figures 3(a), 3(b), and 3(c)) showed normal coronaries.

Bottom Line: Acute myocardial infarction during pregnancy or the postpartum period is rare.We report a case of a 39-year-old postpartum woman who developed non-ST-elevation myocardial infarction due to severe diffuse coronary vasospasm.To our knowledge, this is the first case of angiographically evidenced coronary vasospasm, in a postpartum woman, with resistance to intracoronary nitroglycerin.

View Article: PubMed Central - PubMed

Affiliation: Seton Hall Cardiology Fellowship Program, St. Joseph's Medical Center, Paterson, NJ 07503, USA.

ABSTRACT
Acute myocardial infarction during pregnancy or the postpartum period is rare. We report a case of a 39-year-old postpartum woman who developed non-ST-elevation myocardial infarction due to severe diffuse coronary vasospasm. To our knowledge, this is the first case of angiographically evidenced coronary vasospasm, in a postpartum woman, with resistance to intracoronary nitroglycerin.

No MeSH data available.


Related in: MedlinePlus