ACS in pregnancy 2023

Question 1

Rate of ACS in prengnancy? How much more likely to occur than non pregnant women?

Answer 1

Rates 6.2/100,000 pregnancies

Preg 3-4 x more likely to suffer ACS

Question 2

Leading cause off ACS in pregnancy

Answer 2

Atherosclerosis is now most common 39%

Question 3

When most likely to occur in pregnancy?

Answer 3

o 41% postnatally

Question 4

Which is most common from NSTEMI/STEMI/UA?

Answer 4

STEMI 75% maternal ACS

Question 5

What proportion of ACS due to coronary artery spasm?

Answer 5

2%

Question 6

What ECG changes are normal in pregnancy

Answer 6

 Reduced PR internal
 Sinus tachycardia
 LAD
 Q wave and T wave inversion Lead II, III, aVF
 Twi V1-V3

Question 7

Goldstandard Tx for atherosclerosis and thrombosis ACS

Answer 7

Percutaneous coronary artery dissection

Caution can worsen PASCAD

Question 8

Risk of fetal loss and preterm delivery with thrombolysis

Answer 8

– 6% fetal loss/PTD

Question 9

Which medical treatments/secondary preventions are CI in prengnancy

Answer 9

• Relative CI thromboylsis
• ACEi/ARB
• Thiazide diuretics/spironolactone
• Statin
• DOAC/Warfarin

Caution nitrates

Question 10

When to delivery after ACS?

Answer 10

Wait few weeks if possible
Delivery by 40/40

Question 11

If IHD risk of ACS in future pregnancy

Answer 11

9%

Question 12

When is future pregnancy absolutely contraindicated

Answer 12

WHO IV
Caution WHO III

Question 13

Which contraptions are contraindicated after ACS

Answer 13

COCP

Coils should be inserted in hospital setting