Zawał mięśnia sercowego u 25-letniej rodzącej – opis przypadku

Elżbieta Nowacka^1,2, Wiesław Schubert², Jarosław Galewski², Nikola Niewęgłowska²

Summary
Background. The incidence of acute myocardial infarction during pregnancy is low; the estimated incidence is 1:10 000-30 000, however when it occurs, it is associated with significant maternal and foetal mortality. We describe a case of a 25-yr-old multipara, who died two hours after delivery because of a myocardial infarction. Case report. The patient was admitted to the obstetric department in the 31st week of her pregnancy because of amniorrhoea and intermittent vaginal bleeding. Her first child had been born by caesarean section because of preeclampsia. Her second child was born naturally, but she had suffered from hypertension during the pregnancy. She received intravenous tocolytic therapy, but after three weeks, it was decided to terminate the pregnancy because of increased CRP and severe amniorrhoea. A 1900 g baby, Apgar score 10, was born spontaneously. The placenta was manually removed, and the patient received 5 mg oxytocin and 0.2 mg methergine. She was in a stable condition following the procedure. Two hours later she collapsed and died despite vigorous resuscitation. The post mortem examination revealed fresh focal ischemia of the left anterior wall of the heart. Discussion. Myocardial infarction during the puerperium may occur because of acute vasospasm and/or coronary thrombosis. In the case described, the most likely cause was the preexisting imbalance between prostacyclin and thromboxane, the simultaneous use of two vasoconstrictors, and the manual removal of the placenta.

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