Peripartum myocardial ischemia: A review of Canadian deliveries from 1970 to 1998
The purpose of this study was to evaluate the incidence of peripartum myocardial ischemia in Canada.
We identified the cohort of women who were admitted to Canadian hospitals for delivery between 1970 and 1998 to calculate the incidence rate and to evaluate potential risk factors.
One hundred fourteen of 10,032,375 women delivered in Canadian hospitals between 1970 and 1998 had peripartum myocardial ischemia recorded as a discharge diagnosis. The overall crude incidence rate was 1.1 (95% confidence interval 0.93, 1.37) women with peripartum myocardial ischemia per 100,000 women delivering per year as noted in the Canadian Hospital Morbidity database. Rates did not increase over time but increased with maternal age. Identified risk factors were diabetes mellitus, hyperlipidemia, and chronic heart disease. The case fatality rate among women with the disease was 1.8%.
The incidence of peripartum myocardial ischemia did not increase between 1970 and 1998 in Canada, despite an aging cohort with more prevalent medical comorbidities. Maternal mortality from this event is lower than previously described.
Available from: ncbi.nlm.nih.gov
- "Ischemic heart disease is rare during pregnancy, occurring in approximately one in 10,000 live births. The risk of myocardial infarction (MI) in pregnancy is reported from one per 37,500 to 6.2 per 100,000 deliveries.1–3 The diagnosis is by clinical findings, electrocardiogram (ECG), and measurement of the serum level of the cardiac specific contractile protein, Troponin 1.4, 5 The most common forms of angina are stable and unstable angina, which are usually due to atherosclerosis. "
[Show abstract] [Hide abstract]
ABSTRACT: Acute myocardial infarction (MI) during pregnancy is rare and MI due to Prinzmetal's angina is much rarer. We present a 35-year-old, obese, multigravida, and pre-eclamptic woman, who developed acute anterior wall MI at the 30th week of gestation. On coronary angiography, the second obtuse marginal branch was totally occluded and the right coronary artery (RCA) was normal. Three days later, she had chest pain and ST elevation in the inferior leads. On second angiography, there was narrowing in the RCA, while the obtuse marginal branch was patent. We presume that this discrepancy between the first and second electrocardiograms and angiographic findings was due to Prinzmetal's angina.
Journal of Tehran University Heart Center 05/2012; 7(2):85-9.
Available from: Lawrence C Tsen
[Show abstract] [Hide abstract]
ABSTRACT: EVERY year, the Society for Obstetric Anesthesia and Perinatology celebrates the life and legacy of Gerard Ostheimer, M.D., an obstetric anesthesiologist re-nowned for his wisdom, his passion for life, and his generosity to the society and the specialty. The celebra-tion takes the form of an eponymous lecture given at the Society for Obstetric Anesthesia and Perinatology Annual Meeting with the purpose of evaluating literature contri-butions from a single year that are pertinent to the clinical care and research of obstetric anesthesia pa-tients. From more than 1,400 contributions in 2003, 841 were abstracted in the Society for Obstetric Anesthesia and Perinatology 36th Annual Meeting program syllabus, with general themes summarized in the lecture.This ar-ticle focuses on four advances that are of importance to anesthesiologists who practice within an obstetric set-ting. These include advances in the uniquely human obstetric disease, preeclampsia; a leading cause of ma-ternal death, peripartum hemorrhage; the functional physiology of maternal pain and labor analgesia; and the philosophical issues surrounding delivery of care: ethics and consent. Preeclampsia A pregnancy disorder recognized since antiquity that affects 6 – 8% of all pregnancies, 1 preeclampsia is a lead-ing cause of maternal and perinatal morbidity and mor-tality. Despite the recognition that the disease occurs only within the confines of pregnancy (or in the pres-ence of placental tissue), the etiologic basis of pre-eclampsia eludes detection. 2 The maternal–fetal inter-face has featured prominently in recent investigations, with the leading mechanistic model postulating that ma-ternal genes dictate disease susceptibility, whereas fetal genes, paternal genes, and environmental factors control the ultimate phenotypic expression. 3 The identification of these "preeclampsia" genes, however, has proven difficult because the case– control reports of specific maternal polymorphisms and mutations and the data from the available genome-wide scans have yielded con-flicting results. 3,4 Molecular variants of the maternal genes responsible for angiotensinogen represent prom-ising etiologic candidates for preeclampsia 5 ; to great surprise, less convincing data have been observed with a seemingly ideal contender, nitric oxide synthetase. 6,7 The chromosome 2p13 locus from the genome-wide scan of Arngrimsson et al. 8 seems to be one of the leading maternal genes responsible; however, the results were derived mainly from two large families comprising only 17% of a total of 343 affected individuals from an Icelandic study population. The "Genetics of Preeclamp-sia" (GOPEC) trial recently initiated in 10 centers across the United Kingdom offers significant promise; this pro-spective trial will attempt to identify the genes of 1,000 tightly phenotyped pregnant women with preeclampsia, as well as their parents, children, and partners (or bio-logic fathers of the children). DNA-marker alleles will be identified in candidate gene regions and ultimately ge-nome-wide; transmitted and nontransmitted marker al-leles will then be evaluated to reveal the contribution of maternal, paternal, and fetal genes to the risk of preeclampsia. Among the difficulties in identifying causes and treat-ments for preeclampsia has been the absence of animal models that adequately represent the clinical disease. 9 This noted, a novel experimental model resembling hu-man preeclampsia, suitable for exploring the pathophys-iology of the disease, has been developed. Maynard et al. 10 observed the up-regulation of soluble fms-like ty-rosine kinase 1 (sFlt1) receptors in the placenta of preg-nancies complicated with preeclampsia and a fall within 48 h of delivery; both findings are consistent with the clinical expression of preeclampsia. More importantly, the investigators demonstrated that the exogenous ad-ministration of sFtl1 in pregnant rats produced clinical and pathologic findings classically associated with pre-eclampsia: hypertension, proteinuria, and glomerular en-dotheliosis. 10 Although sFlt1 receptors, a splice variant * Associate Professor in Anaesthesia.
Anesthesiology 04/2005; 102(3):672-9. DOI:10.1097/00000542-200503000-00029 · 5.88 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: The prevalence of coronary artery disease in female patients is increasing due to changing lifestyle patterns including cigarette smoking, diabetes and stress. Since women are delaying childbearing until older age, acute coronary syndrome will more frequently occur during pregnancy. Although rare, acute coronary syndrome during pregnancy often has devastating consequences. It is associated with increased maternal and neonatal mortality and morbidity compared with the nonpregnant situation. Furthermore, it constitutes an important problem for the patient and the treating physician, because the selection of diagnostic and therapeutic approaches is greatly influenced not only by maternal, but also by fetal safety.
Future Cardiology 09/2007; 3(5):559-67. DOI:10.2217/147966126.96.36.1999
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.