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Acute Myocardial Infarction in a Patient with Twin Pregnancy: A Case Report.

ABSTRACT:

Introduction

Acute myocardial infarction (AMI) rarely occurs during pregnancy and presents unique challenges in diagnosis and management. Traditionally, pregnancy has not readily been considered a risk factor for AMI in the emergency department despite the potential for adverse impacts on maternal and fetal health. As cardiovascular risk factors and advanced maternal age become more prevalent in society over time, the incidence will continue to increase. Prior cases with singular gestation have been reported; however, only one previous case during a twin pregnancy was identified in the medical literature.

Case report

We describe a rare case of acute ST-segment elevation myocardial infarction in a 37-year-old woman at 24 weeks gestation with a dichorionic diamniotic twin pregnancy.

Conclusion

It is important for the emergency physician to recognize acute coronary syndrome as a part of the differential diagnosis of chest pain in pregnant patients and be familiar with the diagnostic and management options available for this special population.

SUBMITTER: Michaelis T

PROVIDER: S-EPMC8610456 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:IntroductionAcute myocardial infarction (AMI) is a specific type of coronary artery disease (CAD) caused by the rupture of coronary atherosclerotic plaques. Coronary artery ectasia (CAE) is a rare phenotype of cardiovascular disease that may promote thrombosis and inflammatory responses leading to myocardial infarction due to abnormal dilatation of blood vessels and coronary blood flow disorders. It is a complicated disease and shows interaction between genetic and environmental factors.Patient concernsA 34-year-old male patient was admitted to our hospital on May 12, 2016, with complaints of chest pain for 1?hour duration.DiagnosisCoronary angiography through the emergency medical service (EMS) system showed 100% occlusion at the first turning point of the right coronary artery (RCA), along with tumor-like expansion of the proximal segment of the RCA and the end of the left main (LM) artery. The patient was diagnosed with AMI and CAE. Three-point mutations in the ATG16L1 gene were identified by direct sequencing.InterventionsAfter admission, the patient underwent emergency green channel coronary angiography and percutaneous coronary intervention (PCI) to assess and unblock the stenosis and occlusion of the RCA lumen, but no stenting was performed because the catheter could not pass the second inflection point of the RCA. Aspirin enteric-coated tablets, clopidogrel sulfate tablets, tirofiban hydrochloride, and low molecular weight heparin calcium were given as anticoagulant and antiplatelet therapy. Atorvastatin calcium tablets were used to regulate blood lipid levels. Perindopril and spironolactone were used to inhibit the renin-angiotensin-aldosterone system (RAAS) to reverse myocardial remodeling. Acetylcholinesterase inhibitors (ACEI) and beta blockers were administered to resist ventricular remodeling and improve cardiac function and prognosis after the patient's blood pressure and heart rhythm were stabilized.OutcomesAfter active rescue treatment, the patient recovered and was discharged. A coronary angiogram performed 2?years later showed that the RCA blood flow was restored, and the patient had recovered well.ConclusionThree-point mutations in the ATG16L1 gene were identified in a patient with AMI and CAE, which extended the mutation spectrum of the ATG16L1 gene. Hence, the etiology of coronary artery aneurysmal dilatation is worthy of further investigation.