ACUTE MYOCARDIAL INFARCTION IN A PUERPERA: A CASE REPORT

Abstract

We report a lethal case of acute myocardial infarction in a puerpera. Cardiovascular diseases rank as the leading causes of mortality during pregnancy and the postpartum period, with myocardial infarction (MI) being a rare yet frequently fatal occurrence. Research indicates that MI typically manifests between 6 to 12 weeks postpartum, though instances may also occur at later stages. The reported case is interesting in terms of the mismatch between the timing of clinical symptoms of acute coronary syndrome (less than 24 hours) in the puerpera and alterations in myocardial infarction (2-3 days), which was diagnosed morphologically. Therefore, we searched for possible causes that led to the clinical and morphological changes described above. At first glance, the main cause of myocardial infarction development is coronary artery dissection with the formation of hematoma in the wall of the blood vessel, which narrows its lumen and leads to necrosis of the heart muscle. A brief analysis of the case has established that ischemic damage to the myocardium preceded the development of spontaneous coronary artery dissection and could be caused by one of the factors or a combination of them: coronary artery spasm caused by ergometrine and anemia due to uterine atony-related postpartum hemorrhage. The formation of intramural hematoma of the vascular wall, which narrowed the lumen of the coronary artery, could be the result of the prescription of antithrombotic therapy, which complicated the health status of the woman and led to death. When providing medical care to puerperas with postpartum hemorrhage, it is necessary to take into account the risk for cardiovascular complications that could develop due to anemia or administration of ergometrine.

Keywords

• ergometrine
• thrombolytics
• coronary angiography
• spontaneous coronary artery dissection