What is the most likely aetiology of her myocardial infarction?


#1

A 22-year-old woman presented with acute chest pains, 2 days after the uncomplicated delivery of her first child, and was found to have an anterior STelevation myocardial infarction. She had no conventional risk factors for coronary artery disease.
What is the most likely aetiology of her myocardial infarction?

A: atherosclerotic plaque rupture
B: coronary artery dissection
C: myocardial bridging
D: paradoxical embolism across patent foramen ovale
E: takotsubo cardiomyopathy

Correct answer: B Explanation B is the best answer. Coronary artery dissection is a well-recognised cause of myocardial infarction in relation to pregnancy. It is the most likely cause in this young patient who is in the early post-partum phase, and who has no recognised risk factors for coronary atherosclerosis…
A: Atherosclerotic plaque rupture is the main alternative to coronary dissection here, and would still need to be excluded, given that it is much the commonest cause of myocardial infarction otherwise.
C: Myocardial bridging is a rare cause of myocardial ischaemia or infarction, as it causes coronary constriction during ventricular systole, whereas coronary blood flow is mainly diastolic.
D: Paradoxical embolism across patent foramen ovale is a rare though wellrecognised cause of myocardial infarction, and may be more prevalent during pregnancy which is a hypercoagulable state.
E: Takotsubo cardiomyopathy is also reco