Coronary artery plaque disruption as cause of acute myocardial infarction during cesarean section with spinal anesthesia

• Published in: Journal of clinical anesthesia Vol. 12; no. 4; pp. 335 - 338
• Main Authors: Kulka, Peter J, Scheu, Christoph, Tryba, Michael, Oberheiden, Ralf, Zenz, Michael
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2000; Elsevier Science
• Subjects: Abdominal surgery. Urology. Gynecology. Obstetrics; Acute Disease; Adult; Anesthesia; Anesthesia depending on type of surgery; Anesthesia, Obstetrical; Anesthesia, Spinal; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cesarean Section; coronary artery disease; Coronary Disease - complications; Coronary Disease - diagnostic imaging; Coronary Vessels - diagnostic imaging; Female; Humans; Medical sciences; myocardial infarction; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - etiology; plaque disruption; Pregnancy; Ultrasonography; coronary artery disease; cesarean section; Anesthesia, spinal; plaque disruption; myocardial infarction; pregnancy; Human; Infarct; Pathophysiology; Rupture; Cardiovascular disease; Coronary heart disease; Myocardial disease; Intrathecal administration; Case study; Regional anesthesia; Atherosclerotic plaque; Surgery; Myocardium; Complication; Female; Delivery; Cesarean section
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/S0952-8180(00)00161-6

A 31-year-old parturient delivered twins at 35 weeks’ gestation by cesarean section with spinal anesthesia. Following anesthesia induction, hypotension and bradycardia occurred, and were immediately treated with theodrenaline plus cafedrin (Akrinor) and atropine. Blood pressure and heart rate increased to 180/100 mmHg and 140 beats per minute, respectively. Several minutes later, the patient developed a myocardial infarction (MI) that she survived after intensive care treatment without sequelae. Although the coronary angiography showed normal coronary vessels, an intravascular ultrasound study demonstrated an atheroma in the left main coronary artery with ruptured fibrous cap. Laboratory screening for risk factors of coronary artery disease (CAD) showed hypercholesterinemia, increased factor VII activity, and hyperfibrogenemia. Angiographically normal coronary vessels are frequently found in pregnant patients who suffered MI. In these patients, coronary spasms have been discussed as the major mechanism of disease. Our case demonstrates that a significant CAD may be present despite angiographically normal findings. Plaque rupture was triggered by hypertension and led to MI as the first symptom of disease. On the basis of these findings, we believe that MI during pregnancy is more often caused by plaque rupture than may be expected, according to the current literature.