Myocardial infarction in the third trimester of pregnancy secondary to an aortic valve thrombus.

BACKGROUND

Myocardial infarction during pregnancy is rare, at an estimated one case per 10,000 women delivered. The overall mortality rate is 28% and is even higher in the second and third trimesters. We report a myocardial infarction secondary to a thrombus that developed on an artificial aortic valve in a 25-year-old woman at 26 weeks' gestation.

CASE

The patient, gravida 6, para 3-0-2-3, presented with an acute myocardial infarction despite antepartum anticoagulant therapy with heparin. During her hospitalization, she experienced a second ischemic event, preterm labor, and a small upper gastrointestinal hemorrhage. Nitroglycerin, sublingual nifedipine, and heparin were used to stabilize her cardiac problems, and her uterine contractions were inhibited with tocolytic agents. At 35 weeks' gestation, she underwent an uncomplicated vaginal delivery of a 2608-g viable male infant.

CONCLUSION

Pregnancy complicated by myocardial infarction due to a valve thrombosis in the third trimester can be managed with careful attention to controlling the cardiac symptoms and preventing premature delivery.