Patient handout

STEMI in pregnancy — non-SCAD etiology (atherosclerotic / embolic / thrombotic)

PRODUCTION

1. Your condition

This handout is for stemi in pregnancy — non-scad etiology (atherosclerotic / embolic / thrombotic). Your care team identified this based on: st elevation on ecg in pregnant patient (any trimester) or postpartum ≤6 wk.

Other reasons your team may use this plan: ischemic chest pain in pregnant patient → urgent workup; differential includes scad, pe, aortic dissection, takotsubo; chest pain in postpartum patient ≤6 wk (peak hypercoagulable + hemodynamic risk window).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
aspirin	162-325 mg load → 81 mg daily	PO	load + daily	AHA 2025 Class I; low-dose ASA (≤150 mg) Class B in pregnancy + endorsed by ACOG for preeclampsia prevention; full STEMI dose acutely defensible per ESC 2018 pregnancy (PMID 30165544)
clopidogrel	600 mg load → 75 mg daily × 12 mo	PO	load + daily × 12 mo	Pregnancy Class B; PREFERRED P2Y12 in pregnancy due to longer safety record vs ticagrelor (Class C, data limited); plan to interrupt 5-7 d before delivery if elective + consider bridging with bivalirudin
heparin_unfractionated	70-100 U/kg IV bolus then infusion to aPTT 1.5-2.5×control	IV	bolus + infusion	Does NOT cross placenta; reversible with protamine; PREFERRED over LMWH peri-cath/peri-delivery for reversibility
metoprolol	25-50 mg PO BID; titrate	PO	BID	Pregnancy Class C but safety record supports use; AVOID atenolol (Class D — FGR); labetalol Class C also acceptable; CAPRICORN extrapolation
labetalol	100-200 mg PO BID; titrate	PO	BID	Pregnancy preferred BB; ACOG 2019 first-line for HTN in pregnancy
atorvastatin	HOLD in pregnancy unless absolute necessity (FDA Class X historical; 2021 FDA reconsidered for high-risk patients)	PO	HOLD	FDA 2021 statement: statin contraindication softened — case-by-case for high-risk patients; pravastatin lowest fetal exposure if needed; restart 6 wk postpartum (or only pravastatin if breastfeeding)
warfarin	AVOID throughout pregnancy	PO	AVOID	Warfarin embryopathy 6-12 wk + fetal hemorrhage throughout; if AC indicated → LMWH (does not cross placenta); restart warfarin postpartum if needed

Plan: Pregnancy-modified STEMI pharmacology — pregnancy-class-aware substitutions

3. When to call your provider

Contact your care team if any of the following happen:

Recurrent ACS → cath + reassess for SCAD vs atherosclerotic vs APS
Pregnancy in setting of prior pregnancy STEMI → MFM + cardiology high-risk pregnancy clinic

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Pregnant patient exposed to fibrinolysis (alteplase/tenecteplase) — ICH risk + placental abruption + fetal hemorrhage; should NEVER be given in pregnancy unless life-threatening PE/stroke with no alternative(life-threatening)
Pregnant patient with cocaine on UDS + STEMI — placental abruption + fetal cocaine exposure + maternal vasospasm; AVOID pure beta-blocker (unopposed alpha worsens)
Fetal distress on continuous monitoring during acute STEMI management (post-PCI or stabilization) requiring emergent delivery while maternal antiplatelet/anticoagulation active(life-threatening)

5. Follow-up

Multidisciplinary cardiology + MFM + lactation: vaginal delivery preferred unless obstetric/cardiac indication; postpartum revascularization if not done acutely; lactation safe meds (avoid amiodarone, ACEi okay postpartum); statin restart 6 wk postpartum if not breastfeeding (or use pravastatin-only if breastfeeding per limited data); contraception planning (avoid estrogen — IUD/progestin preferred)

6. Sources

Guideline: 2025 ACC/AHA ACS + ESC 2018 Pregnancy CV Disease + AHA 2024 Pregnancy + ACS Statement + ACOG Pregnancy Guidelines