PP032 THE RATES OF MORTALITY AND MORBIDITY ACCORDING TO PATIENTS' STRATEGIES OF TREATMENT, WHO HAVE SEVERE CORONARY ARTERY DISEASE (original) (raw)

2010, International Journal of Cardiology

Objective: Acute myocardial infarction (AMI) during the early postpartum period is rare but may be associated with poor maternal outcome. We report an inferior AMI in 30-year-old woman with mitral valve replacement (MVR) during early postpartum period successfully treated with tirofiban. Case: A 30-year-old woman with MVR was admitted to our emergency department because of sudden onset chest pain on the third day after delivery. She did not have dyspnea, syncope, haemoptysis, or fever. She gave no history of cardiovascular risk factors. Her medical history included an operation of MVR approximately ten months ago. She had used warfarin for four months then began to take enoxaparine (2*1 SC) during pregnancy. Electrocardiography showed ST-segment elevation of 2 mm in leads DII, DIII, aVF and reciprocal ST depression in DI, aVL, V1-3. Echocardiography revealed hypokinesis of the inferior wall, with an overall ejection fraction estimated at 45%. Emergency coronary angiography demonstrated extensive thrombus load in the left circumflex coronary artery (LCx) and first obtus margin brunch (OM1). Because of significant amount of thrombus load and TIMI III flow in LCx and OM1, angioplasty did not performed. Additionally thrombolytic therapy was not administrated due to presence of vaginal hemorrhage. She was treated with aspirin, clopidogrel, metoprolol, enapril, rosuvastatin, nitroglycerin, unfractionated heparin and tirofiban infusion. Four hours after starting the therapy ST-segment normalization in inferior and V1-3 lead on electrocardiography was observed. The patient received tirofiban infusion for 48 hours. Total resolution of thrombus in LCx and OM1 was observed in control coronary angiography three days after medical therapy. Patient did not have any problems during follow-up period and she was discharged ten days after the admission. Discussion/Conclusion: AMI due to extensive intracoronary thrombus load without evidence of atherosclerotic disease in early postpartum period is a rare condition. For a patient that has got AMI due to massive thrombus and that is not suitable for percutaneous coronary intervention and has got contraindication to thrombolytic therapy, tirofiban infusion must be kept in mind. However, further studies are required to determine the efficacy and safety of tirofiban therapy (alone or adjunctive) use for AMI.