Diagnostic and Management Considerations in a High-Risk Pregnant Patient with Ischemic Cardiomyopathy (JACC Case Reports April 2024)-Article: Diagnostic and Management Considerations in a High-Risk Pregnant Patient with Ischemic Cardiomyopathy

Article: Diagnostic and Management Considerations in a High-Risk Pregnant Patient with Ischemic Cardiomyopathy

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This document discusses a case involving a 43-year-old pregnant woman with ischemic cardiomyopathy presenting with cardiogenic shock. The patient had a history of chronic hypertension, diabetes, and substance abuse. She presented with symptoms of shortness of breath, chest pain, and leg swelling, leading to a diagnosis of multivessel obstructive coronary artery disease. The patient was managed by a multidisciplinary team and underwent coronary angiography to assess her condition. Despite not having an intervenable lesion, defining her coronary anatomy was crucial for treatment planning. The patient's heart failure was managed with medications, but she left against medical advice before optimization. She was discharged with a wearable defibrillator due to her severely reduced ejection fraction. The importance of considering ischemic evaluation in pregnant patients with new heart failure, the safety of coronary angiography during pregnancy in selected cases, and the significance of multidisciplinary collaboration in managing high-risk pregnant patients with cardiovascular disease are highlighted in this case. The document emphasizes the need for early involvement of expert teams in cardio-obstetrics for such cases to ensure optimal care and outcomes.

Keywords

pregnant woman

ischemic cardiomyopathy

cardiogenic shock

chronic hypertension

diabetes

substance abuse

multivessel obstructive coronary artery disease

coronary angiography

heart failure management

multidisciplinary collaboration