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Vasospasm Induced Myocardial Ischemia In The Setting Of Postpartum Hemorrhage
Abstract Number: F2C-9
Abstract Type: Case Report/Case Series
A 47-year-old female with history of chronic hypertension and cerebral aneurysm presented in labor with twin gestation at 19 weeks. Additional risks for hemorrhage and myocardial compromise included advanced maternal age, hypertension, multiple gestation, and uterotonic agents in setting of hypovolemia. Twin B’s delivery was complicated by prolonged labor and retained placenta requiring emergent D&C under saddle block anesthesia and estimated blood loss was 2800ml. Post-partum hemorrhage was complicated by new findings of ST elevations in the inferior leads 30 minutes later in the PACU. Emergent cardiac catheterization revealed clean coronary arteries and a diagnosis of coronary vasospasm was made. The incidence of ischemic heart disease in pregnancy is rare (6.2 per 100,000)  however with the increasing technology to aid women conceive and increasing maternal age, the risks of myocardial ischemia have increased in certain patient populations during pregnancy. This patient’s risks factors for MI include advanced maternal age, history of hypertension, and hypovolemia in the setting of uterotonic agents. Several case reports have reported myocardial infarction occurring in pregnancy, including one with a clear diagnosis of coronary vasospasm occurring two weeks post-partum . To our knowledge this is the first case reporting acute ST elevation myocardial infarction occurring as a result of coronary vasospasm in the immediate post-partum period from a mid-pregnancy loss. Careful consideration of intravascular volume status and resuscitation should be given to patients receiving uterotonic agents. Classically, ergot alkaloids have been known to induce coronary vasospasm in patients with known hypertensive disease, however ischemia has also been described in hypovolemic patients in the setting of oxytocin use. Acute management of myocardial ischemia with supportive measures resolved this patient’s symptoms and heart catheterization lead to the diagnosis of coronary vasospasm.
1. A. H. James, M. G. Jamison, M. S. Biswas, L.R. Brancazio,G.K. Swamy, and E. R. Myers, “Acute myocardial infarction in pregnancy: AUnited States population-based study,” Circulation, vol.113, no. 12, pp. 1564–1571, 2006.
2. Koneru et al. “Postpartum Coronary Vasospasm with literature review,” Case Reports in Cardiology vol 2014