Preprint Case Report Version 1 Preserved in Portico This version is not peer-reviewed

Acute Myocardial Infarction Due to Left Main Spontaneous Coronary Artery Dissection Complicated by Cardiogenic Shock in a 36 Weeks Pregnant Woman: Which Comes First?

Paolo Izzo
* ORCID logo ,
Luciano Izzo
,
Paolo Meloni
,
Manfredi Arioti
,
Terenzia Simari
,
Federico Sanchez
,
Cristian Cascione
,
Andrea Montevecchi
,
Chiara Boccherini
,
Fausta Orsi
,
Claudia De Intinis
ORCID logo ,
Sara Izzo
Version 1 : Received: 16 June 2023 / Approved: 20 June 2023 / Online: 20 June 2023 (08:11:40 CEST)

How to cite: Izzo, P.; Izzo, L.; Meloni, P.; Arioti, M.; Simari, T.; Sanchez, F.; Cascione, C.; Montevecchi, A.; Boccherini, C.; Orsi, F.; De Intinis, C.; Izzo, S. Acute Myocardial Infarction Due to Left Main Spontaneous Coronary Artery Dissection Complicated by Cardiogenic Shock in a 36 Weeks Pregnant Woman: Which Comes First?. Preprints 2023, 2023061403. https://doi.org/10.20944/preprints202306.1403.v1 Izzo, P.; Izzo, L.; Meloni, P.; Arioti, M.; Simari, T.; Sanchez, F.; Cascione, C.; Montevecchi, A.; Boccherini, C.; Orsi, F.; De Intinis, C.; Izzo, S. Acute Myocardial Infarction Due to Left Main Spontaneous Coronary Artery Dissection Complicated by Cardiogenic Shock in a 36 Weeks Pregnant Woman: Which Comes First?. Preprints 2023, 2023061403. https://doi.org/10.20944/preprints202306.1403.v1

Abstract

(1) Background: Acute myocardial infarction in pregnancy (pAMI) is a rare event, often caused by non-classical factors rather than atherosclerosis. The management of pAMI poses unique chal-lenges as it requires considering both maternal and fetal well-being.; (2) Methods: We present the case of a 36-week pregnant woman who presented with antero-lateral ST elevation myocardial infarction (STEMI) complicated by cardiogenic shock. To ensure comprehensive decision-making, an emergency Pregnancy Heart Team meeting was convened, comprising interventional cardi-ologists, gynecologists, and anesthesiologists. The team prioritized interventional treatment for pAMI and opted for primary percutaneous coronary intervention (PCI) due to the unstable ma-ternal condition.; (3) Results: The patient underwent primary PCI as the chosen intervention for pAMI. A rapid response gynecology team closely monitored the procedure and was prepared to intervene in case of irreversible hemodynamic compromise leading to cardiac arrest. A caesarean section was deemed necessary if cardiac activity was not restored within 4 minutes.; (4) Conclusions: Managing pAMI requires a multidisciplinary approach that balances the maternal and fetal well-being. In this particular case, the Pregnancy Heart Team decided to prioritize interventional treatment with primary PCI due to the unstable maternal condition. The presence of a closely monitored gynecology team ensured prompt action in case of complications.

Keywords

acute myocardial infarction in pregnancy (pAMI), cardiogenic shock; coronary artery dissection; STEMI; percutaneous coronary intervention (PCI)

Subject

Medicine and Pharmacology, Cardiac and Cardiovascular Systems

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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