Peripartal Myocardial Infarction Caused by Placenta Embolus

A-32-year old second gravid woman without known cardiovascular risk factors underwent an elective cesarean delivery during the 33rd week of gestation because of intrauterine growth retardation secondary to placenta insufficiency. The latter was most likely related to a previously diagnosed symptomatic antiphospholipid syndrome. Twenty hours after an uncomplicated delivery, the patient reported a sudden onset of typical chest pain after a severe cough attack. Pulmonary embolism was ruled out by computed tomography. Chest pain had subsided 1 hour after onset following the initiation of medical therapy. The ECG showed transient, nonsignificant ST-segment changes (Figure 1) in the inferior leads, and cardiac enzymes were slightly elevated, reaching peak values 12 hours later. The diagnosis of subacute non–ST-elevation myocardial infarction (peak troponin I 2.240 μg/L [<0.010 μg/L], peak creatine kinase 1316 U/L [<170 U/L], and peak creatine kinase MB 87.9 μg/L [<4.0 μg/L ]) was established, and the patient was transferred to the coronary care unit. Transthoracic echocardiography showed a modest inferolateral hypokinesia with preserved global systolic left ventricular function (Movie I in the online-only Data Supplement). The patient underwent coronary …