Coronary insufficiency during pregnancy. epidemiology, methods of diagnosis and treatment

Authors

  • S. O. Siromakha SI «Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine», Kyiv, Ukraine
  • S. S. Arvanytakvy SI «Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine», Kyiv, Ukraine
  • S. A. Rudenko SI «Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine», Kyiv, Ukraine
  • V. V. Lazorishenetc SI «Amosov National Institute of Cardiovascular Surgery of NAMS of Ukraine», Kyiv, Ukraine

DOI:

https://doi.org/10.15574/PP.2019.79.32

Keywords:

pregnancy, coronary insufficiency, acute coronary syndrome

Abstract

The article presents a literature review on coronary insufficiency (CI) in pregnant women. Epidemiology of CI is outlined. The causes of this pathology in pregnant women and its symptoms are described. Main methods of diagnosis and treatment of CI are determined. Coronary insufficiency refers to acute and chronic diseases characterized by a mismatch between myocardial oxygen demand and coronary blood supply. The incidence of CN depends on a family history of atherosclerotic diseases, dyslipidemia, activation, nutrition, stress, blood sugar, smoking, and use of oral contraceptives in the past. The major reasons for CI development are atherosclerotic disorders of the coronary arteries, due to common risk factors for CI, as well as hemodynamic, hemostatic and hormonal changes during pregnancy. Coronary insufficiency poses a threat to the health and life of the pregnant woman and her baby. Diagnosis of CI during pregnancy is difficult and may include risks to the fetus. First of all, non-invasive methods are used, as they do not pose such risks. The introduction of percutaneous coronary intervention (PCI) as a treatment method reduces maternal mortality by 15%. To reduce the teratogenic effects of ionizing radiation, PCI is recommended after 15 weeks of gestation with the end of the embryonic organogenesis. However, in acute coronary syndrome, PCI is performed on an emergency basis at any time during pregnancy. Coronary artery bypass grafting is also a possible option for emergency myocardial revascularization. Coronary artery bypass grafting on a «working» heart is an operation of choice when endovascular methods cannot be used. According to the literature, postoperative mortality of pregnant women during surgery does not differ from mortality in the «not pregnant» group of patients, but fetal mortality reaches up to 20%, especially with the use of cardiopulmonary bypass. Before prescribing drugs for the cardiovascular system, their effect on uterine blood flow and the fetus should be considered. Pregnant women with CI need to be hospitalized in highly specialized healthcare institutions, on the basis of which there is a pregnancy heart team and where there is the possibility of emergency aid to both the pregnant, and the newborn.
No conflict of interest were declared by the authors.

References

Siromakha SO, Lazoryshynets VV, Berehovyi OA, Hulak BH, Marchenko MV. (2017). Osoblyvosti anasteziolohichnoho zabezpechennia u vahitnykh iz kardialnoiu patolohiieiu. Visnyk sertsevo-sudynnoi khirurhii. 1 (27): 105—109.

Lazoryshynets VV, Davydova IuV, Limanskaya AIu, Siromakha SO. (2019). Difficult GUCH patient in obstetric practice: multidisciplinary approach to cardio-perinatal management. Perinatologiya i pediatriya. 1 (77): 5—11. https://doi.org/10.15574/PP.2019.77.5

Siromakha SO. (2017). Multydystsyplinarna dopomoha vahitnym ta porodilliam z kardialnoiu patolohiieiu v Ukraini. Vrachebnoe delo. 3—4 (1142): 152—157.

Angela J Kealey. (2010). Coronary artery disease and myocardial infarction in pregnancy: A review of epidemiology, diagnosis, and medical and surgical management. Can J Cardiol. Jun-Jul; 26 (6): e185-e186. https://doi.org/10.1016/S0828-282X(10)70397-4

Arnoni RT, Arnoni AS, Bonini RC et al. (2003). Risk factors associated with cardiac surgery during pregnancy. Ann Thorac Surg. 76 (5): 1605—1608. https://doi.org/10.1016/S0003-4975(03)01188-3

Bauer TW, Moore GW, Hutchins GM. (1982). Morphologic evidence for coronary artery spasm in eclampsia. Circulation. 65: 255—259. https://doi.org/10.1161/01.CIR.65.2.255; PMid:7198518

Bernal JM, Miralles PJ. (1986). Cardiac surgery with cardiopulmonary bypass during pregnancy. Obstet Gynecol Surv. 41: 1—6. https://doi.org/10.1097/00006254-198601000-00001; PMid:3510407

Brenner B. (2004). Haemostatic changes in pregnancy. Thromb. Res. 114 (5—6): 409—414. https://doi.org/10.1016/j.thromres.2004.08.004; PMid:15507271

Burlew BS. (1990). Managing the pregnant patient with heart disease. Clin Cardiol. 13: 757—762. https://doi.org/10.1002/clc.4960131103; PMid:2272132

Carpenter MW, Sady SP, Hoegsberg B et al. (1988). Fetal heart rate response to maternal exertion. JAMA. 259: 3006—3009. https://doi.org/10.1001/jama.259.20.3006; PMid:3285041

Chambers CE, Clark SL. (1994). Cardiac surgery during pregnancy. Clin Obstet Gynecol. 37: 316—323. https://doi.org/10.1097/00003081-199406000-00009; PMid:8033446

CLASP: a randomized trial of low-doseaspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women. (1994). CLAPS (Collaborative low-dose aspirin study in pregnancy) collaborative group. Lancet. 343 (8898): 619—629. https://doi.org/10.1016/S0140-6736(94)92633-6

Coolman M, de Groot CJ, Steegers EA et al. (2006). Concentrations of plasminogen activators and the inhibitors in blood preconceptionally, during and after pregnancy. Eur J Obstet Gynecol Reprod Biol. 128 (1—2): 22—28. https://doi.org/10.1016/j.ejogrb.2006.02.004; PMid:16584829

ESC Guidelines on the management of cardiovascular diseases during pregnancy (2011). The Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC), 26 August.

Garry D, Leikin E, Fleisher AG, Tejani N. (1996). Acute myocardial infarction in pregnancy with subsequent medical and surgical management. Obstet Gynecol. 87: 802—804.

Hankins GD, Wendel GD, Jr, Leveno KJ, Stoneham J. (1985). Myocardial infarction during ptegnancy: A review Obstet Gynecol. 65: 139—146.

James AH, Jamison MG, Biswas MS et al. (2006). Acute myocardial infarction in pregnancy: a United Stated population-based study. Circulation. 113 (12): 1564—1571. https://doi.org/10.1161/CIRCULATIONAHA.105.576751; PMid:16534011

James AH, Jamison MG, Biswas MS et al. (2006). Acute myocardial infarction in pregnancy: a United Stated population-based study. Circulation. 113 (12): 1564—1571. https://doi.org/10.1161/CIRCULATIONAHA.105.576751; PMid:16534011

Karamermer Y, Roos-Hesselink JW. (2007). Coronary heart disease and Pregnancy. Future Cardiol. 3 (5): 559—567. https://doi.org/10.2217/14796678.3.5.559; PMid:19804311

Katz H. (1922). About the sudden natural death in pregnancy. During delivery and the puerperium. Archiv Fur Gynaekologie. 115: 283—312.

Ladner HE, Danielsen B, Gilbert WM. (2005). Acute myocardial infarction in pregnancy and the puerperium: a population-based study. Obstet Gynecol. 105 (3): 480—484. https://doi.org/10.1097/01.AOG.0000151998.50852.31; PMid:15738011

Lewis CE, Funkhouser E, Raczynski JM, Sidney S, Bild DE, Howard BV. (1996). Adverse effect of pregnancy on high density lipoprotein (HDL) cholesterol in young adult women. Am J Epidemiol. 144: 247—254. https://doi.org/10.1093/oxfordjournals.aje.a008919; PMid:8686693

Nanette K Wenger. (2015). Transforming Cardiovascular Disease Prevention in Women: Time for the Pygmalion Construct to End. Cardiology. 130: 62—68. https://doi.org/10.1159/000370018; PMid:25531091

Parry AJ, Westaby S. (1996). Cardiopulmonary bypass during pregnancy. Ann Thorac Surg. 61: 1865—1869. https://doi.org/10.1016/0003-4975(96)00150-6

Pollack PS, Shields KE, Burnett DM et al. (2005). Pregnancy outcomes after maternal exposure to simvastatin and lovastatin. Birth Defects Res. A Clin Mol Teratol. 73 (11): 888—896. https://doi.org/10.1002/bdra.20181; PMid:16163683

Pomini F, Mercogliano D, Cavalleti C, Caruso A, Pomini P. (1996). Cardiopulmonary bypass in pregnancy. Ann Thorac Surg. 61: 259—268. https://doi.org/10.1016/0003-4975(95)00818-7

Robson SC, Dunlop W, Boys RJ, Hunter S. (1987). Cardiac output during labour. Br Med J (Clin. Res. Ed.) 295 (6607): 1169—1172. https://doi.org/10.1136/bmj.295.6607.1169; PMid:3120929 PMCid:PMC1248244

Robson SC, Hunter S, Moore M, Dunlop W (1987). Haemodynamic changes during the puerperium: a Doppler and M-mode echocardiographic study. Obstet Gynecol. 94 (11): 1028—1039. https://doi.org/10.1111/j.1471-0528.1987.tb02286.x; PMid:3322367

Roth A, Elkayam U. (1996). Acute myocardial infarction associated with pregnancy. Ann Intern Med. 125 (9): 751—762. https://doi.org/10.7326/0003-4819-125-9-199611010-00009; PMid:8929010

Schaefer C, Hannemann D, Meister R et al. (2006). Vitamin K antagonists and pregnancy outcome. A multi-centre prospective study. Thromb. Haemost. 95 (6): 949—957. https://doi.org/10.1160/TH06-02-0108; PMid:16732373

Shade GH, Jr, Ross G, Bever FN, Uddin Z, Devireddy L, Gardin JM. (2002). Troponin I in the diagnosis of acute myocardial infarction in pregnancy, labor, and post-partum. Am J Obstet Gynecol. 187: 719—720. https://doi.org/10.1067/mob.2002.126648; PMid:12501092

Siu SC, Sermer M, Colman JM et al. (2001). Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 104 (5): 515—521. https://doi.org/10.1161/hc3001.093437; PMid:11479246

Spaanderman ME, WIllekes C, Hoeks AP, Ekhart TH, Peeters LL. (2000). The effect of pregnancy on the compliance of large arteries and veins in healthy parous control subjects and women with a history of preeclampsia. Obstet Gynecol. 183 (5): 1278—1286. https://doi.org/10.1067/mob.2000.106750; PMid:11084578

Turrentine MA, Braems G, Eamirez MM. (1995). Use of thrombolytics for the treatment of thromboembolic disease during pregnancy. Obstet Gynecol Surv. 50: 534—541. https://doi.org/10.1097/00006254-199507000-00020; PMid:7566831

Uri Elkayam et al. (2016). High-Risk Cardiac Disease in Pregnancy. J of the Am College of Cardiology. 68 (4), July. https://doi.org/10.1016/j.jacc.2016.05.048; PMid:27443437

Yoshihiro J. Akashi et al. (2010). Stress Cardiomyopathy. Ann Rev Med. 61: 271—286. https://doi.org/10.1146/annurev.med.041908.191750; PMid:19686084

Downloads

Issue

No. 3(79) (2019): Ukrainian Journal of Perinatology and Pediatrics

Section

Reviews

License

The policy of the Journal “Ukrainian Journal of Perinatology and Pediatrics” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).

Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.

Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.

The use of published materials for commercial purposes is strongly prohibited.