“AMI must be recognized by emergency physicians and internists as well as ob.gyns,” she said, and patients should be referred to a cardiologist promptly if AMI is suspected.
Consider AMI in any symptomatic pregnant patient with a suggestive history and rule it out only after a detailed cardiac evaluation, Dr. Warnes advised.
If AMI is diagnosed, “manage the patient, preferably in an ICU where combined cardiac and obstetric care can be provided with a multidisciplinary team approach,” she said.
Risk Categories for Therapy Options For Treating AMI in Pregnant Women
Drug therapies that were noted in the review fit into the Food and Drug Administration's pregnancy risk categories as follows:
Risk Category B (Drug has shown no risk to the fetus based on animal studies, or animal studies showed a risk that was not confirmed by controlled studies of women in the first trimester of pregnancy.)
▸ Organic nitrates: nitroglycerine.
▸ β-Adrenergic blocking agents: metoprolol.
▸ Aldosterone blocker: eplerenone.
▸ Low-molecular-weight heparin.
▸ Antiplatelet therapy: thienopyridine derivatives (clopidogrel, ticlopidine), glycoprotein IIb/IIIa inhibitors (eptifibatide, tirofiban).
Risk Category C (Drug poses potential risk to the fetus and should only be given if the potential benefit justifies potential risk.)
▸ Organic nitrates: isosorbide dinitrate.
▸ β-Adrenergic blocking agents: atenolol.
▸ Calcium channel blockers: nifedipine, diltiazem, verapamil.
▸ Unfractionated heparin.
▸ Antiplatelet therapy: aspirin, glycoprotein IIB/IIIa inhibitors (abciximab).
▸ Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor antagonists (ARBs). Contraindicated for pregnant patients.
▸ Morphine sulfate: One study of 448 exposures showed no evidence of teratogenic effects.
Risk Category X (Drug has shown evidence of causing fetal abnormalities and the risk to the fetus outweighs any possible benefit).
▸ HMG-CoA Reductase Inhibitors (statins): Use of these drugs is not recommended in pregnancy because of evidence of inhibition of DNA replication and of fetal abnormalities in animal studies.
Source: J. Am. Coll. Cardiol. 2008;52:171–80