CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 4, May 2013
AFRICA
e13
Case Report
Acute ST-elevation myocardial infarction in early
puerperium due to severe left main coronary stenosis in
a woman with familial hyperlipidaemia
TAHIR BEZGIN, ALI ELVERAN, CEM DOĞAN, ALI KARAGÖZ, ŞEYHMUS KÜLAHÇIOĞLU, GÖKHAN KAHVECI,
ALI METIZN ESEN
Abstract
Acute myocardial infarction (AMI) is a rare but often cata-
strophic event during pregnancy, delivery or puerperium,
leading to a high mortality rate. It has different pathogenic
mechanisms, such as atherosclerosis, vasospasm, thrombosis
and coronary dissection. Although MI has been reported in
pregnant women at all stages of pregnancy and postpartum,
it occurs more commonly in the third trimester and most
commonly involves the anterior wall. Evidence suggests
that pregnancy itself is an independent risk factor for MI,
conferring a three- to four-fold higher risk than that of non-
pregnant women matched for age, possibly due to the unique
physiological changes required to meet the demands of a
growing foetus.
We report a case of a 27-year-old woman with familial
hyperlipidaemia presenting with myocardial infarction six
days after caesarean delivery, secondary to severe left main
coronary stenosis (LMCA), who was treated with emergency
coronary artery bypass grafting (CABG).
Keywords:
pregnancy-related myocardial infarction, left main
stenosis, peripartum myocardial infarction
Submitted 19/5/12, accepted 18/3/13
Cardiovasc
J Afr
2013;
24
: e13–e16
DOI: 10.5830/CVJA-2013-016
Acute myocardial infarction (AMI) is a rare but often a
catastrophic event during pregnancy, delivery or puerperium,
leading to a high mortality rate.
1-4
It has different mechanisms,
such as atherosclerosis, vasospasm, thrombosis and coronary
dissection. Maternal mortality after MI has decreased from
5.1–37%
1,2
to 5.1–7.3%, owing to improvements in diagnosis and
treatment.
3,4
It was reported with a frequency of one in 35 700 to
one in 16 129 pregnancies. However, the frequency is increasing
due to the growing number of pregnancies in women in their
forties or fifties.
1,3,4
Although MI has been reported in pregnant women at all
stages of pregnancy and postpartum, it occurs more commonly
in the third trimester and most commonly involves the anterior
wall.
5
Evidence suggests that pregnancy itself is an independent
risk factor for MI, conferring a three- to four-fold higher risk
than that of non-pregnant women matched for age, possibly
due to the unique physiological changes required to meet the
demands of a growing foetus.
4
Case report
A 27-year-old woman with familial hypercholesterolaemia
presented to the emergency room with symptoms of dyspnoea
and chest pain over two days. She had had a successful labour
via caesarean section six days earlier. She denied smoking
and using alcohol or illicit drug abuse. There was no family
history of premature coronary artery disease or haematological
abnormalities.
On physical examination she was pale, apprehensive
and clammy. Arterial blood pressure was 90/50 mmHg. The
electrocardiogram showed 4-mm ST-segment elevation in the
aVR lead and ST depression in the anterior and inferior leads
(Fig. 1). An echocardiogram showed severe apical hypokinesia
with a drastic decrease in left ventricular systolic function
(ejection fraction
=
35%). There were eruptive xanthomas in
various areas of her body (Fig. 2).
Cardiology Clinic, Kartal Koşuyolu Heart and Research
Hospital, Cevizli-Kartal, Istanbul, Turkey
TAHIR BEZGIN, MD,
ALI ELVERAN, MD
CEM DOĞAN, MD
ALI KARAGÖZ, MD
ŞEYHMUS KÜLAHÇIOĞLU, MD
GÖKHAN KAHVECI, MD
ALI METIZN ESEN, MD
Fig. 1. Electrocardiogram showing ST-segment elevation
in the aVR lead and ST-segment depression in the ante-
rior and inferior leads.
