Silent Myocardial Infarction in Pregnancy Uncovered During Routine Antenatal Echocardiographic Screening

BACKGROUND: Pregnancy-associated myocardial infarction (PAMI) is a rare but potentially life-threatening condition with significant fetomaternal implications. CASE SUMMARY: A 22-year-old primigravida at 27 weeks of gestation was incidentally found to have left ventricular apical akinesia during echocardiographic screening. Cardiac magnetic resonance imaging confirmed an infarct in the territory of the left anterior descending artery, and coronary computed tomography angiography at 80 days after the event showed nonobstructive coronaries, suggesting a healed spontaneous coronary artery dissection or resolved thrombus. The patient was managed medically but experienced fetal demise at 28 weeks of gestation. DISCUSSION: PAMI differs from myocardial infarction in the general population. Spontaneous coronary artery dissection is the leading cause during pregnancy, followed by atherosclerosis. This case highlights the diagnostic complexity of PAMI and underscores the value of multimodal imaging in pregnant patients presenting with cardiac symptoms. TAKE-HOME MESSAGES: Cardiovascular evaluation in pregnancy is crucial, particularly in resource-limited settings. A high clinical suspicion is key to timely diagnosis and appropriate management to improve maternal and fetal outcomes.