Management of Coronary Artery Disease and Arrhythmias

Abstract

Although coronary artery disease is seldom encountered in women of childbearing age (16–45 years of age), the consequences of coronary disease are considerable, especially in pregnant women. Acute coronary syndrome (ACS) occurring in pregnancy can have devastating effects on mother and child. ACS in pregnancy has other causes than in the non-pregnant state. In the review of Roth and Elkayam only 40 % of the cases (41 of 103 patients) were caused by coronary artery stenosis (Roth and Elkayam 2008). Other causes were thrombus (in 8 % of cases), coronary artery dissection (27 %) and vascular spasm (2 %); normal coronary arteries were found in 13 % of the patients (Roth and Elkayam 2008). Pregnancy has shown to increase the risk of ACS three- to fourfold (James et al. 2006). Between 1991 and 2000 the overall incidence of pregnancy related ACS was reported to be 2.7 per 100,000 deliveries (Ladner et al. 2005). A decade later James et al. published on risk factors for ACS during pregnancy and reported an incidence of 6.2 per 100,000 deliveries between 2000 and 2002 (James et al. 2006). The rising incidence can be explained in three ways: firstly improved diagnostic tests, especially troponin assessment, have resulted in more women with acute chest pain being diagnosed with ACS; secondly, an increase in known cardiovascular risk factors is seen in the pregnant population and finally, maternal age has increased in the Western World (Ventura et al. 2004). The most important risk factors for ACS during pregnancy are hypertension and maternal age (Cecchini et al. 2010). In addition to cardiovascular risk factors, a few obstetric risk factors for ACS during pregnancy have been discovered. The most important is multiparity; others include: a history of preeclampsia, post-partum haemorrhage, transfusions and post-partum infections (Ladner et al. 2005).