Clinical cases of myocardial infarction in pregnant women: the role of hereditary thrombophilia

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Abstract

Acute myocardial infarction during pregnancy is a threatening complication with high maternal and perinatal mortality. According to the literature, hereditary thrombophilia is commonly associated with obstetric disorders and susceptibility to venous thrombosis, whereas arterial part of the vasculature, including coronary, is rarely involved. The article describes two clinical cases of pregnant women with acute myocardial infarction and post-infarction cardiosclerosis, in whom hereditary thrombophilia, associated with the gene PAI-1-675 polymorphism, was diagnosed. Mothers of both patients had suffered myocardial infarction at a young age, while past history of only one pregnant woman was remarkable for multiple perinatal losses. Myocardial infarction may manifest with intense headache mirroring systemic angiospasm.

Based on the clinical observations of acute myocardial infarction in pregnancy, one could conclude that measurements of troponin levels that might be false negative should be done repeatedly, while the signs of transmural myocardial injury at ECG can evolve into those of an intramural myocardial infarction. Miscarriage and fetoplacental insufficiency have been found in the patients with combination of hereditary thrombophilia and myocardial injury. Coronary artery damage in pregnant women can be the result of hereditary thrombophilia, most often associated with the PAI-1-675 gene polymorphism, as well as its combination with the heterozygous state of other genes.

The absence of past perinatal losses and venous thromboembolism in pregnant women with myocardial infarction does not exclude hereditary thrombophilia, and additional work-up of the patient and the proband family is mandatory to exclude the underlying pathology. The course of myocardial infarction may not require an intracoronary intervention, and treatment may consist of non-fractionated or low molecular weight heparin and calcium antagonists.

About the authors

S. R. Mravyan

Moscow Regional Scientific Research Institute for Obstetrics and Gynecology

Author for correspondence.
Email: sergeymrav@list.ru
ORCID iD: 0000-0002-9591-8433

Sergey R. Mravyan - MD, PhD, Leading Research Fellow, Obstetrical and Physiological Department.

9-88 Krasnoproletarskaya ul., Moscow, 127006, Tel.: +7 (495) 621 71 39

Russian Federation

T. S. Kovalenko

Moscow Regional Scientific Research Institute for Obstetrics and Gynecology

Email: 1akmoniiag@mail.ru
ORCID iD: 0000-0001-8995-6727

Tatiana S. Kovalenko - MD, PhD, Leading Research Fellow, Obstetrical and Physiological Department.

22a Pokrovka ul., Moscow, 101000, Tel.: +7 (495) 621 71 39

Russian Federation

I. O. Shuginin

Moscow Regional Scientific Research Institute for Obstetrics and Gynecology

Email: 1akmoniiag@mail.ru
ORCID iD: 0000-0002-9456-8275

Igor O. Shuginin - MD, PhD, Head of Obstetrical and Physiological Department.

22a Pokrovka ul., Moscow, 101000; Tel.: +7 (495) 621 71 39

Russian Federation

T. S. Budykina

Moscow Regional Scientific Research Institute for Obstetrics and Gynecology

Email: budyt@mail.ru
ORCID iD: 0000-0001-9873-2354

Tatiana S. Budykina - MD, PhD, Head of Clinical Diagnostic Laboratory.

22a Pokrovka ul., Moscow, 101000; Tel.: +7 (495) 621 71 39

Russian Federation

S. I. Fedorova

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru
ORCID iD: 0000-0003-2957-3403

Svetlana I. Fedorova - MD, PhD, Head of Department of Functional Diagnostics.

61/2 Shchepkina ul., Moscow, 129110; Tel.: +7 (499) 681 55 71

Russian Federation

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Copyright (c) 2020 Mravyan S.R., Kovalenko T.S., Shuginin I.O., Budykina T.S., Fedorova S.I.

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