Abstract
The risk of manifestations of ischaemic heart disease (IHD) in fertile women is elevated during pregnancy and the post-partum period. With increasing maternal age and a higher prevalence of cardiac risk factors, the incidence of IHD during pregnancy is rising. However, information in the literature is scarce. We therefore performed a retrospective cohort study and systematically reviewed the overall (1975–2013) and contemporary (2005–2013) literature concerning IHD presenting during pregnancy or in the post-partum period. We report two cases of IHD with atypical presentation during pregnancy or post-partum. In our review, we describe 146 pregnancies, including 57 contemporary cases (2005–2013). Risk factors for IHD were present in 80 %. Of the cases of IHD, 71 % manifested in the third trimester or the post-partum period, and 95 % presented with chest pain. The main cause was coronary dissection (35 %), or thrombus/emboli (35 %) in the more contemporary group. Maternal mortality was 8 % (6 % in the contemporary group), and the main cardiac complication was ventricular tachycardia (n = 17). Premature delivery rate was 56 %, and caesarean section was performed in 57 %. Perinatal mortality was 4 %. In conclusion, IHD during pregnancy or in the post-partum period has high maternal mortality and morbidity rates. Also, premature delivery and perinatal mortality rates are high.Electronic supplementary materialThe online version of this chapter (doi:10.1007/s12471-015-0677-6) contains supplementary material, which is available to authorized users.
Highlights
Cardiovascular disease (CVD) is the leading cause of death in men and women in the Western world [1,2,3]; 50 % is due to ischaemic heart disease (IHD) [1]
Her vitamin K antagonist was replaced by acetylsalicylic acid and a full dose of low-molecular-weight heparin during pregnancy until the fifth day post-partum
In contrast to the atypical presentation in our case series, IHD during pregnancy mainly presents with chest pain and during the third trimester or the post-partum period
Summary
Cardiovascular disease (CVD) is the leading cause of death in men and women in the Western world [1,2,3]; 50 % is due to ischaemic heart disease (IHD) [1]. Pre-menopausal women are relatively protected against atherosclerosis by their hormonal status, the risk of manifestations of IHD is increased during pregnancy and in the post-partum period [4,5,6]. This is due to cardiovascular and haemodynamic changes and hypercoagulability occurring during pregnancy [7,8,9].
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