Acute Myocardial Infarction in a 19-Year-Old Female Owing to Hypercoagulable State of Pregnancy and the Puerperium

Author Affiliations: From the Division of Cardiology, Department of Medicine, University of Louisville, Louisville, Kentucky. The authors report no conflicts of interest regarding the content herein. Manuscript submitted February 4, 2008, provisional acceptance given April 14, 2008, and accepted April 16, 2008. Address for correspondence: Buddhadeb Dawn, MD, Division of Cardiology, 550 S Jackson St. ACB 3rd Floor, University of Louisville, Louisville, KY 40292. E-mail: buddha@louisville.edu

_______________________________________________ ABSTRACT: A well-recognized, yet rare, complication of pregnancy is acute myocardial infarction (AMI). In some cases, the hypercoagulable state associated with pregnancy has been the primary contributor to coronary artery thrombosis. However, we describe a clinical presentation of an AMI occurring in a 19-year-old with no traditional cardiac risk factors, not during pregnancy, but in the puerperium.

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J INVASIVE CARDIOL 2008;20:E262–E264 The incidence of acute myocardial infarction (AMI) associated with pregnancy is approximately 3–10 cases per 100,000 deliveries, and is highest in multigravidas older than 33 years of age, during the third trimester of either their first or second pregnancy.1 The strongest independent predictors of infarction are traditional cardiovascular risk factors, namely hypertension, diabetes and smoking.1,2 However, in almost 26% of patients with pregnancy-related AMI, an underlying acquired (antiphospholipid antibody syndrome and hyperhomocystinemia) or inherited (antithrombin III, protein C, protein S, and factor V Leiden) thrombophilia acts as the primary contributor to the development of acute coronary artery thrombosis.1,2 Although the majority of pregnancy-related AMIs do occur during pregnancy, approximately 27% occur in the puerperium (the period immediately following delivery that extends 6–8 weeks postpartum).1,2 Of the latter, approximately 21% of these patients present with isolated thrombi in the absence of coronary artery disease.2 We describe a 19-year-old patient with early presentation of a non-ST-elevation AMI (NSTEMI) secondary to in situ coronary thrombosis without atherosclerotic disease, and with neither traditional risk factors nor underlying known thrombophilia. Case Report. A 19-year-old African-American female (para 1011) with recently diagnosed peripartum cardiomyopathy and no traditional cardiac risk factors was admitted on day 33 postpartum of a spontaneous vaginal delivery with unstable angina of approximately 60 minutes duration. Her electrocardiogram revealed new symmetric T-wave inversions in leads V5–6, I and aVL. The creatine phosphokinase-MB level was 210 UI/mL (normal range, 0 to 25 UI/mL) and the cardiac troponin T level was 3.65 µg/L (normal,

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