A case of pregnancy-associated acute myocardial infarction with refractory ventricular fibrillation and heart failure Tomoya Hasegawa, MD, Hiroaki Tabata,

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A case of pregnancy-associated acute myocardial infarction with refractory ventricular fibrillation and heart failure Tomoya Hasegawa, MD, Hiroaki Tabata, MD, Mitsuru Kagoshima, MD, FJCC, Hiroyuki Okada, MfD, Hiroshi Aida, MD, Wataru Shoin, MD, Kyoko Shoin, MD, Uichi Ikeda, MD, PhD, FJCC Journal of Cardiology Cases Volume 14, Issue 1, Pages 13-16 (July 2016) DOI: 10.1016/j.jccase.2016.03.001 Copyright © 2016 Japanese College of Cardiology Terms and Conditions

Fig. 1 (A) Electrocardiogram (ECG) monitor detects ventricular fibrillation. (B) After electrical defibrillation, ECG shows no remarkable ST-T changes or QT prolongation. (C) ECG at discharge reveals diffuse abnormal Q and T-wave inversion on the anterior and inferior leads. Journal of Cardiology Cases 2016 14, 13-16DOI: (10.1016/j.jccase.2016.03.001) Copyright © 2016 Japanese College of Cardiology Terms and Conditions

Fig. 2 (A) Coronary angiographic imaging shows the obstructed proximal left anterior descending artery (LAD) (black arrow). (B) Coronary angiography after guide wire passage through the LAD reveals the spiral dissection (thin black arrow). Intravascular ultrasonography imaging demonstrates intramural hematoma from proximal to middle sections of the LAD (a–e, white asterisks). (C) Angiographic imaging after stent implantation shows normal flow of the LAD without dissections (black asterisk). Journal of Cardiology Cases 2016 14, 13-16DOI: (10.1016/j.jccase.2016.03.001) Copyright © 2016 Japanese College of Cardiology Terms and Conditions

Fig. 3 Transthoracic echocardiography and multi-slice computed tomographic imaging. Apical four-chamber view during diastolic phase (A) and systolic phase (B) shows broad anterior akinesia (white arrows) and depressed left ventricular ejection fraction at 30%. (C) Multi-slice computed tomographic imaging of the left anterior descending artery (LAD) performed 3 months after the initial event shows stent thrombosis (white arrow) and distal collateral flow (black arrow). It also shows another coronary dissection in the proximal LAD (*), as well as wall thinning of infarcted area (**). Journal of Cardiology Cases 2016 14, 13-16DOI: (10.1016/j.jccase.2016.03.001) Copyright © 2016 Japanese College of Cardiology Terms and Conditions