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Pregnancy increases fatal heart attack risk

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CHICAGO -- Pregnancy increases the risk of a fatal heart attack, a new study shows, even in apparently healthy women who don't have the normal risk factors for heart disease.

Heart attacks during pregnancy -- while rare -- prove fatal for about seven per cent of women who have them, a rate about three times higher than what doctors would expect in non-pregnant women of the same age, says Uri Elkayam, lead author of a study presented here at the annual meeting of the American College of Cardiology.

Heart attacks affect about one in every 16,000 deliveries, occurring mostly in the last three months of pregnancy or first few weeks after delivery, says Elkayam, a professor of medicine and obstetrics-gynecology at the University of Southern California.

Heart attacks during and just after pregnancy have different origins than typical heart attacks, an issue that can make them harder to treat, says Elkayam, who has completed three studies of the problem since 1995. In fact, standard heart attack therapies can make a pregnant or newly delivered woman's heart attack even worse, endangering her life, he says.

Normally, the most common cause of a heart attack is a narrowing of the arteries because of fatty plaques. However, this caused only about one-third of heart attacks in pregnant women or new mothers, according to Elkayam's new study, of 150 cases from 2005 to 2011. Instead, nearly half of the heart attacks were caused by a problem called coronary dissection, when the inner and outer layers of an artery around the heart peel apart from each other. That can allow blood to flow in between layers of blood vessels, blocking the artery.

Doctors need to be careful not to blindly follow the normal heart attack treatment guidelines, Elkayam says. Giving these women a clot-busting drug -- which normally helps patients -- can actually make the artery tear even further. So can imaging the heart using another common test, called coronary angiography. In seven of 129 women, performing an angiography made the rupture worse. One of those women died, and another later died while waiting for a heart transplant. Four of the women needed immediate heart bypass surgery, he says.

When pregnant women come to the hospital with heart attack symptoms, "the biggest problem is that we honestly don't know what to do with them," says Martha Gulati, director of preventive cardiology and women's cardiovascular health at Ohio State's Wexner Medical Center, who wasn't involved in the new study. "We don't even know how to advise them about whether they should try to get pregnant again."

Given these dangers, Elkayam says doctors should try to evaluate patients non-invasively, such as through an EKG, which measures the heart's rhythm, and stress testing, which can involve running on a treadmill. If doctors feel they must insert a balloon into the artery to save a mother's life, they should do it as quickly and carefully as possible.

Pregnancy can increase heart attack risk in several ways, says cardiologist Nieca Goldberg, medical director of NYU Langone Medical Center's Tisch Center for Women's Health. Pregnancy changes a woman's balance of hormones and makes her more prone to blood clots. Because of the increased demands of the fetus, her blood volume increases by 50 per cent.

And while the women in the study appeared largely healthy, Goldberg notes that 25 per cent were smokers. Quitting smoking is one of the most important things women can do to protect themselves and the baby, Goldberg says.

-- USA Today

Republished from the Winnipeg Free Press print edition March 27, 2012 D1

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