Wingerter Kelly E, O'Dell Kimberly R, Anglim Annemarie J, Bailey Alison L
Department of Medicine, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS 39216, USA.
Department of Medicine, University of Tennessee College of Medicine Chattanooga-Internal Medicine, 975 East Third Street, Chattanooga, TN 37403, USA.
Eur Heart J Case Rep. 2021 Mar 10;5(3):ytab080. doi: 10.1093/ehjcr/ytab080. eCollection 2021 Mar.
Acute myocardial infarction in pregnancy is occasionally due to spontaneous coronary artery dissection (SCAD). Although uncommon, the majority of cases of pregnancy-associated SCAD (pSCAD) has critical presentations with more profound defects that portend high maternal and foetal mortality, and frequently necessitate preterm delivery. This is a case of pSCAD with ongoing ischaemia that required temporary mechanical circulatory support (MCS) and emergent revascularization, while the pregnancy was successfully continued to early-term.
A 30-year-old woman G2P1 at Week 32 of gestation with no medical history, presented to the emergency department with severe chest pain. An electrocardiogram showed ST-segment elevation in the anterolateral leads. An emergent cardiac catheterization revealed dissection of the proximal left anterior descending (LAD) artery with TIMI (thrombolysis in myocardial infarction) 3 flow. Although initially stable, she later experienced recurrent chest pain and developed cardiogenic shock, necessitating MCS, and emergent revascularization. She was stabilized and remained closely monitored in the hospital prior to vaginal delivery at early-term.
This case of pSCAD at Week 32 of gestation complicated by refractory ischaemia illustrates the complexity of management, which requires a multi-disciplinary team to reduce both maternal and foetal mortality. Conservative management of SCAD, while preferred, is not always possible in the setting of ongoing ischaemia, particularly if complicated by cardiogenic shock. A thorough weighing of risks vs. benefits and ongoing discussions among multiple subspecialists in this case allowed for the stabilization of the patient and subsequent successful early-term delivery.
妊娠期急性心肌梗死偶尔由自发性冠状动脉夹层（SCAD）引起。虽然不常见，但大多数妊娠相关SCAD（pSCAD）病例都有严重表现，伴有更严重的缺陷，预示着母婴高死亡率，且常常需要早产。这是一例伴有持续性缺血的pSCAD病例，需要临时机械循环支持（MCS）和紧急血运重建，同时成功维持妊娠至早期。
一名30岁、孕2产1、妊娠32周的女性，无病史，因严重胸痛就诊于急诊科。心电图显示前侧壁导联ST段抬高。紧急心脏导管检查显示左前降支（LAD）近端夹层，心肌梗死溶栓治疗（TIMI）血流3级。虽然最初病情稳定，但她后来反复出现胸痛并发展为心源性休克，需要MCS和紧急血运重建。她病情稳定，在医院密切监测，直至早期经阴道分娩。
这例妊娠32周的pSCAD病例并发难治性缺血，说明了管理的复杂性，这需要多学科团队来降低母婴死亡率。SCAD的保守治疗虽然是首选，但在持续性缺血的情况下并不总是可行，特别是如果并发心源性休克。在这个病例中，对风险与益处进行全面权衡，并在多个亚专科之间持续讨论，使患者病情稳定，并随后成功实现早期分娩。
