The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Acute Myocardial Infarction Associated with Pregnancy

Arie Roth, MD; and Uri Elkayam, MD
[+] Article, Author, and Disclosure Information

From the Tel-Aviv Medical Center and Sackler School of Medicine, Tel-Aviv, Israel; and the University of Southern California School of Medicine, Los Angeles, California. Requests for Reprints: Uri Elkayam, MD, University of Southern California School of Medicine, Division of Cardiology, 2025 Zonal Avenue, Los Angeles, CA 90033. Current Author Addresses: Dr. Roth: Department of Cardiology, Ichilov Hospital, 6 Veitzman, Israel.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;125(9):751-762. doi:10.7326/0003-4819-125-9-199611010-00009
Text Size: A A A

Purpose: To review available information on the epidemiology, cause, diagnosis, prognosis, and treatment of acute myocardial infarction during pregnancy or in the early postpartum period and to develop guidelines for the management of this condition.

Data Sources: MEDLINE and Index Medicus searches and a manual search of bibliographies from reviewed articles.

Study Selection: Published reports of well-documented acute myocardial infarction during pregnancy or the early postpartum period or potentially relevant information.

Data Extraction: 125 well-documented cases of myocardial infarction were identified.

Data Synthesis: The highest incidence seems to occur in the third trimester and in multigravidas older than 33 years of age. Acute myocardial infarction during pregnancy is most commonly located in the anterior wall. The maternal death rate was 21%; death occurred most often at the time of acute myocardial infarction or within 2 weeks of the infarction and was usually related to labor and delivery. Most fetal deaths were associated with maternal deaths. Coronary artery morphology was studied in 54% of described patients. Coronary atherosclerosis with or without intracoronary thrombus was found in 43% of patients, coronary thrombus without atherosclerotic disease in 21%, coronary dissection in 16%, and normal coronary arteries in 29%.

Conclusions: Acute myocardial infarction during pregnancy or the early postpartum period is rare but may be associated with high risk. Although atherosclerosis can be documented in many cases, coronary dissection and arteries that are normal on angiography are common, especially in acute myocardial infarction occurring in the peripartum or postpartum period. Early diagnosis is often hindered by the normal changes of pregnancy and low level of suspicion. Management should follow the usual principles of care for acute myocardial infarction. However, selection of diagnostic and therapeutic approaches may be greatly influenced by fetal safety.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Spontaneous Coronary Artery Dissection. Curr Cardiol Rep 2016;18(7):60.
The actions of relaxin on the human cardiovascular system. Br J Pharmacol Published online May 30, 2016;
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.