Peripartum myocardial infarction associated with coronary spasm and acquired protein S deficiency: A case report – DocWire News

RATIONALE:

Coronaryangiography (CAG) findings of acute myocardial infarction (AMI) in pregnant women are characterized by a high incidence of normalcoronaryarteries. This is the first report of AMI with normalcoronaryarteries during pregnancy, showingcoronaryspasm and pregnancy-related acquired protein S (PS) deficiency.

A 30-year-old Japanese woman was admitted to an emergency department. One hour before admission, she developed sudden onset of precordial discomfort, back pain, and dyspnea. She was a primigravida at 39 weeks gestation and had no abnormality in the pregnancy thus far. She had no history of heartdisease, diabetes, hypertension, dyslipidemia, deep vein thrombosis (DVT), smoking, or oral contraceptive use and no family history of ischemic heartdisease, hemostasis disorder, or DVT. She did not take any medication.

Electrocardiography showed ST-segment elevations in leads II, III, aVF, and V2-V6. Heart-type fatty acid-binding protein was positive. Echocardiography showed hypokinesis of the anterior interventricular septum and inferior wall. Continuous intravenous infusion of isosorbide dinitrate was initiated.Coronarycomputed tomography angiography revealed diffuse narrowing of the apical segment of the left anterior descendingcoronaryartery. Three hours after admission, troponin T became positive, and the following enzymes reached their peak levels: creatine kinase (CK), 1,886U/L; CK-muscle/brain, 130U/L. She was diagnosed with transmural AMI due to severecoronaryspasm and administered benidipine hydrochloride. Five hours after admission, premature membrane rupture occurred.

Emergency cesarean section was performed. There were no anesthetic or obstetrical complications during the operation. On postpartum day 1, the free PS antigen level was low (29%). On postpartum day 18, she was discharged with no reduction in physical performance.

Four months after the infarction, CAG showed normalcoronaryarteries. Acetylcholine provocation test showed diffuse vasospasm in thecoronaryartery. She was advised that her next pregnancy should be carefully planned. Two years after delivery, free PS antigen level was within normal range, at 86%. She had not experienced recurrence of angina during the 2-year period. Her child was also developing normally.

In addition tocoronaryspasm, pregnancy-related acquired PS deficiency may be involved in AMI etiology.

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Peripartum myocardial infarction associated with coronary spasm and acquired protein S deficiency: A case report - DocWire News