Ischemic Heart Disease in Pregnancy: AHA statement
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The recent AHA scientific statement on MI with nonobstructive coronary arteries offers a comprehensive diagnostic algorithm.Treatment should be tailored to the underlying pathophysiology. Pregnancy in women with preexisting coronary artery disease is considered to be very high risk. The probability of developing ischemic. cardio-obstetrics team is essential when these women are counseled about the increased cardiovascular risks with a future pregnancy

Ischemic heart disease during pregnancy constitutes a rare but potentially fatal condition. The third trimester and postpartum are the highest-risk periods. A multidisciplinary team approach should be adopted,, and the treatment strategy is guided by the clinical presentation. In patients with atherosclerotic ST-segment– elevation MI, timely coronary reperfusion by the percutaneous coronary intervention (PCI) is recommended. An invasive approach is also recommended in patients with non–ST-segment–elevation MI who are unstable or have a high atherosclerotic burden. Stable patients at low risk can be managed conservatively.

Angiography is the gold standard for the diagnosis of ischemic heart disease in pregnancy. In the case of atherosclerotic plaque rupture or coronary thrombosis, PCI with stent implantation is recommended. Because pregnant women were generally excluded from stent trials, scarce evidence is available for this population. Post-PCI low-dose aspirin is considered safe throughout pregnancy, and clopidogrel may be used with caution for the shortest duration possible. Other antiplatelet agents should be avoided. Pregnancy-related spontaneous coronary artery dissection is a challenging diagnosis in clinical practice. Similar to the general population, conservative management with inpatient monitoring is recommended for most patients, with a high rate of lesion recovery within months of its occurrence. Women with a history of this condition who become pregnant should be monitored very closely.

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