Non-ST Elevation Myocardial Infarction and Coronary Artery Stenting in Pregnancy in a Woman with Resistant Familial Hyperlipidaemia

  • Anna Liza RoslaniEmail author
  • Abdul Hadi Jaafar
  • Anwar Irawan Ruhani
Case Report

Case Study

A 31-year-old woman with familial hyperlipidaemia and severe coronary artery disease presented at 6 weeks of pregnancy. She had been diagnosed with familial hyperlipidaemia at the age of 7 years, after her father suffered a myocardial infarction in his early forties. She was then lost to follow-up. At the age of 24 years, she had a non-ST elevation myocardial infarction (NSTEMI). A coronary angiogram at that time showed 6 areas of plaque affecting three branches of the coronary arteries. Her medications were simvastatin 20 mg daily, perindopril 4 mg daily, aspirin 150 mg daily and metoprolol 100 mg daily.

After extensive counselling, she insisted on continuing with this pregnancy. Her total cholesterol level was 16.3 mmol/L. Simvastatin and perindopril were stopped due to early pregnancy foetal concerns. She was well until at 20-week gestation, she presented to the Accidents and Emergency Department with acute chest pain and shortness of breath. Her pulse rate was 120 bpm,...


Compliance with Ethical Standards

Conflict of interest

Authors Anna Liza Roslani, Abdul Hadi Jaafar and Anwar Irawan Ruhani have not received any research grants, speaker honorarium, do not own any stock in any related company and are not committee members in any related organization. Anna Liza Roslani declares that she has no conflict of interest. Abdul Hadi Jaafar declares that he has no conflict of interest. Anwar Irawan Ruhani declares that he has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in this study.


  1. 1.
    Eapen DJ, Valiani K, Reddy S, et al. Management of familial hypercholesterolemia during pregnancy: case series and discussion. J Clin Lipidol. 2012;6(1):88–91.CrossRefGoogle Scholar
  2. 2.
    Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. A reference guide to fetal and neonatal risk. 9th edn. Philadelphia: Lippincott Williams & Wilkins; 2011.Google Scholar
  3. 3.
    Pieper PG, Hoendermis ES. Pregnancy in women with pulmonary hypertension. Neth Heart J. 2011;19(12):504–8.CrossRefGoogle Scholar
  4. 4.
    Yusuf S, Bijsterveld NR, Moons AHM. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation: the Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. N Engl J Med. 2001;345:494–502.CrossRefGoogle Scholar
  5. 5.
    Chassot PG, Delabays A, Spahn DR. Perioperative anti-platelet therapy: the case for continuing therapy in patients at risk of myocardial infarction. Br J Anaesth. 2007;99(3):316–28.CrossRefGoogle Scholar
  6. 6.
    Burger W, Chemnitius JM, Kneissl GD et al. Low-dose aspirin for secondary cardiovascular prevention—cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation—review and meta-analysis. J Intern Med. 2005;257:399–414.CrossRefGoogle Scholar
  7. 7.
    Nuttall GA, Brost BC, Connis RT, et al. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology. 2006;105:198–208.CrossRefGoogle Scholar
  8. 8.
    Toleikyte I, Retterstøl K, Leren TP et al. Pregnancy outcomes in familial hypercholesterolemia a registry-based study. Circulation. 2011;124:1606–14.CrossRefGoogle Scholar

Copyright information

© Federation of Obstetric & Gynecological Societies of India 2016

Authors and Affiliations

  • Anna Liza Roslani
    • 1
    Email author
  • Abdul Hadi Jaafar
    • 2
  • Anwar Irawan Ruhani
    • 2
  1. 1.Department of Obstetrics and GynaecologyHospital Tengku Ampuan AfzanKuantanMalaysia
  2. 2.Department of CardiologyHospital Tengku Ampuan AfzanKuantanMalaysia

Personalised recommendations