Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942011000200012
Brazilian Journal of Anesthesiology
Informação Clínica

Infarto agudo do miocárdio na 31ª semana de gravidez: relato de caso

Myocardial infarction in the 31st week of pregnancy: case report

Filipa Pires Duarte; Patrícia O'Neill; Maria João Centeno; Isabel Ribeiro; João Moreira

http://dx.doi.org/10.1590/S0034-70942011000200012 Braz J Anesthesiol, vol.61, n2, p.228-231, 2011
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Resumo

JUSTIFICATIVA E OBJETIVOS: A ocorrência de infarto agudo do miocárdio (IAM) durante a gravidez é rara. Os autores descrevem o caso de IAM numa grávida de 31 semanas e a importância da existência de uma equipe multidisciplinar para sua abordagem. RELATO DO CASO: Grávida de 31 semanas, com antecedentes de tabagismo, alcoolismo e hipertensão, internada após um episódio de síncope. Na admissão, encontrava-se consciente e assintomática, embora hipotensa. O eletrocardiograma evidenciou marcada elevação do segmento ST em DI, AVL, V1-V6. Pesquisa de enzimas cardíacas foi positiva. O ecocardiograma transtorácico demonstrou redução da contratilidade ventricular esquerda e septal e uma fração de ejeção de 30%. A angiografia revelou oclusão proximal da artéria descendente anterior. Por insucesso da angioplastia por balão, foi colocado um stent metálico. A paciente iniciou terapêutica com b-bloqueadores, aspirina e clopidogrel. Em relação ao parto, optou-se por realizar cesariana eletiva, quatro semanas após o IAM. Suspendeu-se o clopidogrel sete dias antes do parto. A função cardíaca pré-operatória foi otimizada com infusão de levosimendana iniciada no dia anterior. A cesariana decorreu sob bloqueio peridural. O período intraoperatório decorreu sem complicações, à exceção de moderada hipotensão facilmente corrigida com fenilefrina. O índice de Apgar do recém-nascido foi de 9/10. CONCLUSÕES: Este é um dos poucos casos de infarto agudo do miocárdio e angioplastia descritos durante a gravidez. Os autores discutem as decisões tomadas pela equipe multidisciplinar, constituída por anestesiologistas, obstetras, cardiologistas e neonatologistas, notadamente no que se refere à dupla antiagregação plaquetária, ao tipo de parto e à anestesia.

Palavras-chave

CIRURGIA, Cardíaca, CIRURGIA, Obstétrica, DOENÇA, Cardíaca

Abstract

BACKGROUND AND OBJECTIVES: The occurrence of acute myocardial infarction (AMI) during pregnancy is rare. The authors describe the case of MI in a 31-week pregnant woman and the importance of a multidisciplinary team for its approach. CASE REPORT: Thirty-one week pregnant woman with history of smoking, alcoholism and hypertension was admitted after an episode of syncope. On admission she was conscious and asymptomatic, although hypotensive. The electrocardiogram showed marked ST-segment elevation in D1, aVL, V1-V6. The cardiac enzymes were positive. The transthoracic echocardiogram showed reduction in septal and left ventricular contractility and an ejection fraction of 30%. Angiography revealed proximal occlusion of the left anterior descending artery. After a non-successful balloon angioplasty, a metallic stent was placed. The patient started therapy with beta-blockers, aspirin and clopidogrel. As for the delivery, we chose to perform a cesarean section four weeks after MI. Clopidogrel was suspended seven days before delivery. The preoperative cardiac function was improved by infusion of levosimendan started the day before. Cesarean section occurred under epidural block. The intraoperative period showed no complications, except for mild hypotension easily corrected with phenylephrine. The Apgar score for the newborn was 9 / 10. CONCLUSIONS: This is one of the few cases of myocardial infarction and angioplasty reported during pregnancy. The authors discuss the decisions taken by the multidisciplinary team consisting of anesthesiologists, obstetricians, neonatologists and cardiologists, particularly with regard to dual antiplatelet therapy, the type of delivery and anesthesia.

Keywords

Pregnancy Complications, cardiovascular, Myocardial Infarction, Angioplasty, Cesarean Section

Referências

James AH, Jamison MG, Biswas MS. Acute myocardial infarction in pregnancy: a United States population-based study. Circulation. 2006;113:1564-1571.

Badui E, Enciso R. Acute myocardial infarction during pregnancy and puerperium: a review. Angiology. 1996;47:739-756.

Hankins GD, Wendel Jr GD, Leveno KL. Myocardial infarction during pregnancy: a review. Obstet Gynecol. 1985;65:139-146.

Chaithiraphan V, Gowda RM, Khan IA. Peripartum acute myocardial infarction: management perspective. Am J Ther. 2003;10:75-77.

Ventura SJ, Mosher WD, Curtin SC. Trends in pregnancy rates for the United States, 1976-97: an update. Natl Vital Stat Rep. 2001;49:1-9.

Ladner HE, Danielsen B, Gilbert WM. Acute myocardial infarction in pregnancy and the puerperium: a population based study. Obstet Gynecol. 2005;105:480-484.

Schumacher B, Belfort MA, Card RJ. Successful treatment of acute myocardial infartion during pregnancy with tissue plasminogen activator. Am J Obstet Gynecol. 1997;176:716-719.

Ahearn GS, Hadjiliadis D, Govert JA. Massive pulmonary embolism during pregnancy successfully treated with recombinant tissue plasminogen activator: a case report and review of treatment options. Arch Intern Med. 2002;162:1221-1227.

Sebastian C, Scherlag M, Kugelmass A. Primary stent implantation for acute myocardial infarction during pregnancy: use of abciximab, ticlopidine, and aspirin. Cathet Cardiovasc Diagn. 1998;45:275-279.

Roth A, Elkayam U. Acute myocardial infarction associated with pregnancy. J Am Coll Cardiol. 2008;52:171-180.

Roth A, Elkayam U. Acute myocardial infarction associated with pregnancy. Ann Intern Med. 1996;125:751-762.

Foading Deffo B. Myocardial infarction and pregnancy. Acta Cardiol. 2007;62:307-312.

Cohen WR, Steinman T, Patsner B. Acute myocardial infarction in a pregnant woman at term. JAMA. 1983;250:2179-2181.

Bembridge M, Lyons G. Myocardial infarction in the third trimester of pregnancy. Anaesthesia. 1988;43:202-204.

Blanchard DG, Shabetai R. Cardiac Diseases. Maternal-Fetal Medicine. 2004:835-840.

Ng K, Parsons J, Cyna AM. Spinal versus epidural anaesthesia for caesarean section. Cochrane Database Syst Rev. 2004.

Newsome LT, Weller RS, Gerancher JC. Coronary artery stents: II. Perioperative considerations and management. Anest Analg. 2008;107:570-590.

McLachlan CS, Tay SK, Almsherqi Z. Atherothrombotic events and clopidogrel therapy. CMAJ. 2007;176.

Karabulut H, Toraman F, Evrenkaya S. Clopidogrel does not increase bleeding and allogenic blood transfusion in coronary artery surgery. Eur J Cardiothorac Surg. 2004;25:419-423.

Hasenfuss G, Pieske B, Castell M. Influence of the novel inotropic agent levosimendan on isometric tension and calcium cycling in failing human myocardium. Circulation. 1998;98:2141-2147.

Lata I, Gupta R, Sahu S. Emergency management of decompensated peripartum cardiomyopathy. J Emerg Trauma Shock. 2009;2:124-128.

Benlolo S, Lefoll C, Katchatouryan V. Successful use of levosimendan in a patient with peripartum cardiomyopathy. Anesth Analg. 2004;98:822-824.

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