CORONARY MICROVASCULAR DISEASE IN A PREGNANT PATIENT WITH HISTORY OF ANTIPHOSPHOLIPID SYNDROME: CASE REPORT. Enfermedad microvascular coronaria en gestante con antecedente de síndrome antifosfolípidos

Abstract

Objective: To report the case of a pregnant patient with a history of antiphospholipid syndrome in whom coronary microvascular disease was documented, where antenatal medical treatment led to improved prognosis and maternal-perinatal outcome.

Materials and methods: The case of a multipregnant woman with a pregnancy of 29.6 weeks, referred from a first level hospital with a diagnosis of acute coronary syndrome, is described; where the diagnosis of microvascular disease could be clarified and an adequate management was carried out. The patient was discharged from the institution with a correct diagnosis and was linked to the high-risk obstetric program for prenatal care and continued her outpatient follow-up with both the perinatology and cardiology services. A review of the literature published in the Medline databases via PubMed, Embase, SciELO and UptoDate® was carried out with the search terms: “pregnancy” and “coronary microvascular disease”. The search was limited by language (articles in English and Spanish).

Results: A single case series was retrieved that met the inclusion and exclusion criteria. All patients were given aspirin during pregnancy. No patient presented adverse cardiovascular outcomes with the established management. No patient had a history of antiphospholipid syndrome

Conclusions: Given the history of antiphospholipid syndrome in a patient with chest pain, coronary microvascular disease should be considered as a differential diagnosis. These patients benefit from starting antiplatelet and anticoagulant therapy as soon as the diagnosis is made. Studies are required to evaluate the safest and most effective management of this condition.