Acute Coronary Syndrome in Pregnancy

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Acute coronary syndrome (ACS) describes a set of symptoms caused by sudden, reduced blood flow to the heart. This may include a heart attack, also known as myocardial infarction. ACS is a medical emergency that needs to be treated promptly to correct blood flow and prevent complications, including death.

What causes ACS

ACS occurs when the coronary arteries ­– the blood vessels that deliver oxygen and nutrients to your heart – become blocked with buildups of fatty plaques. The plaques can break off and form clots, which block the flow of blood to the heart. Without the oxygen and nutrients that the blood supplies, the cells of the heart muscle can die.

The risk of ACS increases with older age, high blood pressure, high cholesterol, cigarette smoking, physical inactivity, an unhealthy or high-fat diet, overweight and obesity, diabetes, and a family history of heart disease or stroke. A COVID-19 infection is also a risk factor for ACS.

If you have high blood pressure, preeclampsia, or diabetes during pregnancy, you are at increased risk for ACS and other forms of heart disease during your pregnancy and even afterwards.

 Symptoms of ACS

The signs and symptoms of ACS appear suddenly. The most notable symptom is abrupt, severe chest pain, but you may also experience the following:

  • Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck, or jaw
  • Nausea or vomiting
  • Indigestion
  • Shortness of breath
  • Sudden, heavy sweating
  • Lightheadedness, dizziness, or fainting
  • Unusual or unexplained fatigue
  • Feeling restless or apprehensive

Unfortunately, some of these symptoms are difficult to distinguish from normal pregnancy discomforts. Chest pain during pregnancy is fairly common and not usually due to a cardiovascular cause, but radiating, severe, sudden-onset chest pain may signal a serious acute event. Mild shortness of breath is often normal, but severe or progressive shortness of breath may be a sign of a more serious condition, such as ACS. Pregnancy may also be associated with decreased exercise tolerance or increased fatigue with normal activities, but an irregular heartbeat or chest pain with exercise or even emotions may indicate ACS.

Heart disease and pregnancy

The rate of heart disease in pregnancy is increasing due to lifestyle factors such as smoking, obesity, stress, older age of mothers, and pre-existing or co-existing diseases such as diabetes. Overall, heart disease is a leading cause of death during pregnancy.

ACS occurs in 1 out of every 10,000 pregnancies. While this is considered a rare occurrence, ACS occurs 3 to 4 times more often in pregnant women than in non-pregnant women of the same age.

Pregnancy induces changes to your body, including the cardiovascular system, that can put you at risk for ACS. First, an increased heart rate and stroke volume (i.e., the amount of blood pumped each time your heart beats) increase the heart’s demand for oxygen. Also, changes in blood pressure (owing to gestational hormones) and pregnancy-related anemia can alter the delivery of oxygen to the heart. Pain, anxiety, and stress also increase the workload on the heart. Further, pregnancy induces a pro-coagulative or hypercoagulative state: simply, your blood clots more easily. This prevents excessive bleeding during delivery but also makes it easier for clots to form, which can travel to your heart and block blood flow.

Treatment of ACS

The treatment of ACS depends on the precise cause of the symptoms. Surgical options and medications are available to restore normal blood flow to the heart and prevent future complications, but not all of the therapeutic options are appropriate during pregnancy. You and your doctor will consider the severity of your symptoms, your overall health, and the age and health of the fetus before deciding on a treatment plan.

The best treatment for ACS and other cardiovascular diseases is usually prevention. Before, during, and after pregnancy, maintain good heart health by eating a healthy diet, avoiding high-fat foods, engaging in plenty of exercise, and managing stress. If you have personal or family risk factors for heart disease, talk to your doctor about how to keep yourself and your baby healthy.

Jennifer Gibson
Dr. Jennifer Gibson earned a Bachelor of Science degree in Biochemistry from Clemson University and a Doctor of Pharmacy degree from the Medical College of Virginia School of Pharmacy at Virginia Commonwealth University. She trained as a hospital pharmacist and is the author of clinical textbooks, peer-reviewed journal articles, and continuing education programs for the medical community, as well as a contributor to award-winning healthcare blogs and websites. In her free time, she enjoys running, reading, traveling, and spending time with her family.

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