Infarto de miocardio recurrente por disección espontánea de arterias coronarias en el puerperio. Revisión de caso

Abstract

Acute myocardial infarction (AMI) related to pregnancy, or the puerperium is a rare entity, being predominant causes of non-atherosclerotic origin, such as spontaneous coronary dissection; its etiology is associated with physiological cardiovascular changes during pregnancy, as well as hemodynamic stressors, which may include complications for example hemorrhage and hypertensive disorders. Its diagnosis is based on a correct assessment of the patient supported by the use of cardiac biomarkers and electrocardiogram; however, the low frequency of this pathology may go unnoticed within the spectrum of causes of chest pain during pregnancy, a situation that becomes a diagnostic challenge. Arteriography is the gold standard, particularly when there is no access to other diagnostic aids such as intravascular ultrasound, cardiac MRI, or optical coherence tomography. The medical treatment and reperfusion strategy should be individualized according to the conditions and requirements of each patient. In this article, we describe the case of a 43-year-old patient who during the puerperium presented 2 episodes of acute myocardial infarction documented by angiography, confirming recurrent spontaneous coronary artery dissection that benefited from 2 percutaneous coronary interventions as a diagnostic strategy and early reperfusion. This publication arises from the need to recognize AMI as a cause of chest pain during pregnancy or pospartum, to broaden the knowledge of the clinical course and differential diagnosis, as well as the current management of acute coronary syndrome in obstetrics, with a particular focus on coronary dissection as a cause.