STEMI in a Postpartum Woman: A Case Against Risk Factor Bias

Emergency Cardiology Literature Review & Updates with Dr. Amal Mattu

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HPI

A 28-year-old woman, 1 week postpartum, calls 911 for acute chest pressure. She has no significant past medical history or traditional cardiac risk factors. Paramedics obtain the following prehospital ECG that the computer interprets as “nonspecific ST abnormalities”. Trusting the machine, they do not activate a pre-alert, and the patient waits in the hallway for 30 minutes before anyone recognizes the obvious STEMI:

Fortunately, the outcome wasn’t disastrous. But this case raises critical questions:

1. 1. Can young, otherwise healthy women really have ACS without risk factors?
   2. What are the important non-thrombotic causes of ACS?
   3. How can you avoid malpractice traps when ECG and history point to ACS, but risk factors don’t fit?