Pregnant woman with spontaneous coronary dissection successfully resurrected: case report
Main Article Content
Keywords
Dissection, Coronary Disease, Resuscitation, Cardiopulmonary Resuscitation, Pregnancy
Abstract
Background: Spontaneous coronary dissection is a disruption of the arterial wall, with clinical manifestations ranging from unstable angina to sudden cardiac death. It is presented a case of an obstetric patient who is successfully resuscitated after a spontaneous coronary dissection.
Clinical case: 37-year-old female patient with a 33-week pregnancy and a history of preeclampsia in the previous pregnancy. She consulted for a 30-min chest pain. After her admission, the patient presented loss of consciousness and cardiorespiratory arrest. Basic and advanced life supports were given and then she was transferred to the intensive care unit where a dissection of the right coronary artery was diagnosed. After 14 days, the patient was discharged from the hospital without neurological sequelae.
Conclusions: Spontaneous coronary dissection in the obstetric patient corresponds to a medical emergency, in which pharmacological and surgical measures must be implemented early in order to promote the fetal maternal well-being.
References
1. Yip A, Saw J. Spontaneous coronary artery dissection—a review. Cardiovas Diagn Ther. 2015;5(1):37-48. doi:10.3978/j.issn.2223-3652.2015.01.08
2. Ya'qoub L. Spontaneous coronary artery dissection in a pregnant woman associated with fetal complication:a case report and review of literature. Cardiovasc Revasc Med. 2019;20(11S):46-48. doi:10.1016/j.carrev.2019.05.015
3. Havakuk O, Goland S, Mehra A, Elkayam U. Pregnancy and the risk of spontaneous coronary artery dissection:an analysis of 120 contemporary cases. Circ Cardiovasc Interv. 2017;10(3):e004941. doi:10.1161/CIRCINTERVENTIONS.117.004941
4. Tweet MS, Hayes SN, Codsi E, Gulati R, Rose CH, Best PJ. Spontaneous coronary artery dissection associated with pregnancy. J Am Coll Cardiol. 2017;70(4):426-35. doi:10.1016/j.jacc.2017.05.055
5. Al-Hussaini A, Adlam D. Spontaneous coronary artery dissection. Heart. 2017;103(13):1043-51. doi:10.1136/heartjnl-2016-310320
6. Buppajarntham S, Junpaparp P, Shah M, Phowthongkum P, Rammohan HRS. Spontaneous coronary artery dissection following a preeclampsia pregnancy. Int J Cardiol. 2014;173(2):e3-e4. doi:10.1016/j.ijcard.2014.03.070
7. Pretty HC. Dissecting aneurysm of coronary artery in a woman aged 42:rupture. Br Med J. 1931;1:667. doi:10.1136/bmj.1.3667.667
8. Rosas-Peralta M, Borrayo-Sánchez G, Madrid-Miller A, Ramírez-Arias E, Pérez-Rodríguez G. Hipertensión durante el embarazo:el reto continúa. Rev Med Inst Mex Seguro Soc. 2016;54(Suppl 1):90-111.
9. Soskin PN, Yu J. Resuscitation of the pregnant patient. Emerg Med Clin North Am. 2019;37(2):351-63. doi:10.1016/j.emc.2019.01.011
10. Rose CH, Faksh A, Traynor KD, Cabrera D, Arendt KW, Brost BC. Challenging the 4-to 5-minute rule:from perimortem cesarean to resuscitative hysterotomy. Am J Obstet Gynecol. 2015;213(5):653-6. doi:10.1016/j.ajog.2015.07.019
11. Bennet TA, Zelop CM. Cardiopulmonary resuscitation (CPR) in pregnancy. En:Phelan JP, editor. Critical care obstetrics. 6th ed. Hoboken, NJ:Wiley Blackwell;2018. 183-92.
12. Healy ME, Kozubal DE, Horn AE, Vilke GM, Chan TC, Ufberg JW. Care of the critically ill pregnant patient and perimortem cesarean delivery in the emergency department. J Emerg Med. 2016;51(2):172-7. doi:10.1016/j.jemermed.2016.04.029
13. Jeejeebhoy FM, Zelop CM, Lipman S, Carvalho B, Joglar J, Mhyre JM, et al. Cardiac arrest in pregnancy:a scientific statement from the American Heart Association. Circulation. 2015;132(18):1747-73. doi:10.1161/CIR.0000000000000300
14. Katz VL, Dotters DJ, Droegemueller W. Perimortem cesarean delivery. Obstet Gynecol. 1986;68:571-6.
15. Zelop CM, Einav S, Mhyre JM, Martin S. Cardiac arrest during pregnancy:ongoing clinical conundrum. Am J Obstet Gynecol. 2018;219(1):52-61. doi:10.1016/j.ajog.2017.12.232
16. Schaap TP, Overtoom E, van den Akker T, Zwart JJ, van Roosmalen J, Bloemenkamp KW. Maternal cardiac arrest in the Netherlands:a nationwide surveillance study. Eur J Obstet Gynecol Reprod Biol. 2019;237:145-50. doi:10.1016/j.ejogrb.2019.04.028
17. Beckett V, Knight M, Sharpe P. The CAPS Study:incidence, management and outcomes of cardiac arrest in pregnancy in the UK:a prospective, descriptive study. BJOG. 2017;124(9):1374-81. doi:10.1111/1471-0528.14521
18. Einav S, Kaufman N, Sela HY. Maternal cardiac arrest and perimortem caesarean delivery:evidence or expert-based?Resuscitation. 2012;83(10):1191-200. doi:10.1016/j.resuscitation.2012.05.005
19. Kikuchi J, Deering S. Cardiac arrest in pregnancy. Semin Perinatol. 2018;42(1):33-8. doi:10.1053/j.semperi.2017.11.007
20. Brogly N, Schiraldi R, Puertas L, Maggi G, Yanci EA, Maldonado EHM, et al. Pulse contour analysis calibrated by trans-pulmonar thermodilution (Picco Plus®) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy. Braz J Anesthesiol. 2016;66(3):329-32. doi:10.1016/j.bjane.2013.09.006
21. Assaad S, Shelley B, Perrino A. Transpulmonary thermodilution:its role in assessment of lung water and pulmonary edema. J Cardiothorac Vasc Anesth. 2017;31(4):1471-80. doi:10.1053/j.jvca.2017.02.018
22. Eschenhagen T. Therapy of heart failure. En:Brunton LL, Hilal-Dandan R, Knollmann BC, editores. Goodman and Gilman's the Pharmacological Basis of Therapeutics. 13rd ed. New York:McGraw Hill;2018. 527-46.
23. Harjola VP, Giannakoulas G, von Lewinski D, Matskeplishvili S, Mebazaa A, Papp Z, et al. Use of levosimendan in acute heart failure. Eur Heart J Suppl. 2018;20(Suppl I):I2-i10. doi:10.1093/eurheartj/suy039
24. Unverferth DV, Blanford M, Kates RE, Leier CV. Tolerance to dobutamine after a 72 hour continuous infusion. Am J Med. 1980;69(2):262-6. doi:10.1016/0002-9343(80)90387-3
25. Schumann J, Henrich EC, Strobl H, Prondzinsky R, Weiche S, Thiele H, et al. Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome. Cochrane Database Syst Rev. 2018(1):CD009669. doi:10.1002/14651858.CD009669.pub3
26. Uriarte-Rodríguez A, Santana-Cabrera L, Sánchez-Palacios M. Levosimendan use in the emergency management of decompensated peripartum cardiomyopathy. J Emerg Trauma Shock. 2010;3(1):94. doi:10.4103/0974-2700.5⇋
27. Benlolo S, Lefoll C, Katchatouryan V, Payen D, Mebazaa A. Successful use of levosimendan in a patient with peripartum cardiomyopathy. Anesth Analg. 2004;98(3):822-4. doi:10.1213/01.ane.0000099717.40471.83
28. Pierrakos C, Velissaris D, Franchi F, Muzzi L, Karanikolas M, Scolletta S. Levosimendan in critical illness:a literature review. J Clin Med Res. 2014;6(2):75-85. doi:10.14740/jocmr1702w
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