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Case Reports
. 2021 Jan;26(1):e12769.
doi: 10.1111/anec.12769. Epub 2020 Jun 5.

Subendocardial stress in pre-eclampsia

Tomio Tran  1 , Morteza Farasat  1   2 , Mori J Krantz  1   2
Affiliations
Case Reports

Subendocardial stress in pre-eclampsia

Tomio Tran et al. Ann Noninvasive Electrocardiol. 2021 Jan.

Abstract

A primigravida 26-year-old woman who had developed pre-eclampsia with malignant hypertension at 30 weeks of gestation suffered acute myocardial infarction two days postpartum. Electrocardiogram demonstrated diffuse ST-segment depression suggestive of subendocardial ischemia. Echocardiography demonstrated focal asymmetric left ventricular hypertrophy, with a characteristic "basal septal bulge", and a left ventricular mid-cavitary gradient of 51 mmHg. Coronary angiography revealed normal coronary arteries and vascular flow. Peripartum acute myocardial infarction is rare and portends a high mortality. However, to date, only one case of acute myocardial infarction associated with asymmetric left ventricular hypertrophy and pre-eclampsia has been described in the literature.

Keywords: basal septal bulge; left ventricular outflow obstruction; myocardial infarction; pre-eclampsia; pregnancy; subendocardial ischemia.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
12‐lead ECG demonstrates diffuse ST‐segment depression (arrows) with ST‐segment elevation in lead aVR (arrowheads)
Figure 2
Figure 2
Initial Transthoracic echocardiotraphy (a) demonstrates basal septal bulge (arrow), which resolved (b) after treatment of hypertension. RV = right ventricle, RA = right atrium. LA = left atrium. LV = left ventricle
See this image and copyright information in PMC

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