Myocardial infarction in pregnancy

Myocardial infarction in pregnancy is a rare event. It is frequently overlooked as a diagnostic possibility in the young pregnant patient with chest pain, which is frequently ascribed to gastrointestinal causes. The chest pain history should be closely taken. If the pain is not classic for reflux esophagitis, or if it is atypical or crescendo in nature, the potential of a cardiac origin should be entertained. At the very least, an electrocardiogram should be obtained, and a cardiology consultation should be considered. In the patient who in fact has had an ischemic event, consultation among cardiologist, anesthesiologist, and obstetrician should be obtained as early in the course of events as possible. Labor itself represents multiple physiologic changes that must be addressed in the patient with left ventricular dysfunction. Pharmacologic manipulations are central to the management of these patients, and the use of the pulmonary artery catheter to appropriately adjust several different parameters may yield the best outcome. It is hoped that the mortality associated with myocardial infarction can be lowered using these newer technologies.