Enfermedad microvascular coronaria en gestante con antecedente de síndrome antifosfolípidos.

Coronary microvascular disease in a pregnant woman with antiphospholipid syndrome history.

ACUTE coronary syndrome; THERAPEUTICS; ANTIPHOSPHOLIPID syndrome; HIGH-risk pregnancy; HOSPITAL admission & discharge; CHEST pain

Objetivo: reportar el caso de una gestante con antecedente de síndrome antifosfolipidos en quien se documentó enfermedad microvascular coronaria. El tratamiento médico antenatal mejoró el pronóstico y el desenlace maternoperinatal. Presentación del caso: multigestante con embarazo de 29,6 semanas remitida de un hospital de primer nivel con diagnóstico de síndrome coronario agudo. Los estudios revelaron enfermedad microvascular. Con un adecuado manejo, la paciente egresó de la institución y se vinculó al programa de alto riesgo obstétrico. Resultados: el diagnóstico de esta entidad se realizó por descarte con ecocardiograma, electrocardiograma, troponinas y cateterismo. Se indicó tratamiento antiisquémico teniendo en cuenta el riesgo/beneficio; continuó en manejo con aspirina y se obtuvo recién nacido en buenas condiciones generales. Conclusiones: ante el antecedente de síndrome antifosfolípidos en una gestante que cursa con dolor torácico, se debe pensar como diagnóstico diferencial enfermedad microvascular coronaria. Se benefician al iniciar antiagregante y anticoagulante en cuanto se realice el diagnóstico. Se requieren estudios que evalúen el manejo más seguro y efectivo de esta condición. [ABSTRACT FROM AUTHOR]

Objective: to report the case of a pregnant woman with antiphospholipid syndrome history, in whom coronary microvascular disease was documented. Antenatal medical treatment improved prognosis and maternal and perinatal outcomes. Case report: multigravida woman, 29.6 weeks pregnant, diagnosed with acute coronary syndrome, referred from a first level hospital. Diagnostic workup revealed microvascular disease. After receiving adequate management, she was discharged from hospital and included in the high-risk pregnancy program. Results: the diagnosis was made based on echocardiography, electrocardiography, troponin levels and cardiac catheterization. Anti-ischemic therapy was indicated considering the risk-benefit trade-off; management with aspirin was continued and the baby was born healthy. Conclusions: coronary microvascular disease should be considered, as a differential diagnosis in a pregnant woman with chest pain and history of antiphospholipid syndrome. Patients benefit from receiving antiplatelet and anticoagulant therapy soon after the diagnosis is made. Studies are required to evaluate the safest and most effective management of this condition. [ABSTRACT FROM AUTHOR]

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