Heart attacks that occur during pregnancy can be more severe with more complications, according to research performed by Uri Elkayam, MD, professor of medicine at the University of Southern California in Los Angeles, and colleagues. They also occur for different reasons, requiring different management.
The researchers analyzed 150 new cases of heart attacks associated with pregnancy occurring since 2005. The analysis found that most pregnant women did not present with traditional cardiovascular risk factors, such as hypertension, diabetes, or high cholesterol, yet they tended to have more serious heart attacks. Mortality in that patient population was 7%, which is two to three times higher than would be expected in non-pregnant patients of similar age.
While the most common cause of heart attacks in the general population is atherosclerosis, this was only true in one-third of pregnant women. More common among pregnant women was coronary dissection, very rare in non-pregnant patients and thought to occur during and immediately after pregnancy because of weakening of the coronary arterial wall. The researchers also found that coronary dissection may actually be worsened by blind use of guideline- recommended standard therapies such as thrombolytic therapy. Dr. Elkayam concluded that stable and low-risk women with pregnancy-associated heart attack should be treated conservatively.