We identified two cases of pregnancy-related IHD in a teaching hospital over a two-year period. As previously described in this journal, pregnancy-related IHD is rare, with an incidence of 2.8 to 6.2 per 100,000 deliveries described in recent reviews [
2,
3,
6]. In this large teaching hospital, only 14 women of fertile age underwent a coronary angiography during the period searched, and two of them (14%) had pregnancy-related IHD. One of our patients had several risk factors for IHD, consistent with the literature where a high prevalence of risk factors is reported in pregnancy-associated IHD, specifically when atherosclerotic disease is present [
7]. Our second patient, who had a coronary artery dissection, however, had no risk factors for coronary artery disease, which is again consistent with current literature [
7]. Coronary artery dissection, which is rare outside pregnancy, is one of the main aetiologies of acute myocardial infarction during pregnancy or the postpartum period [
7].
Both women presented with chest pain in the postpartum period. This is consistent with the literature, where the majority of cases of acute myocardial infarction during pregnancy present with chest pain in the third trimester or the postpartum period and predominantly involve the anterior myocardial wall [
2,
3,
6].
Both women were treated successfully for IHD and survived. Myocardial infarction during or shortly after pregnancy is a very high-risk condition with maternal mortality rates ranging from 5.1 to 11% [
2,
3,
6]. When a pregnant woman presents with chest pain, the diagnoses that should be considered are pulmonary embolism, aortic dissection and myocardial infarction. ECG and troponin levels should be assessed to diagnose infarction, while echocardiography and computerised tomography are needed to diagnose aortic dissection and pulmonary embolism. Percutaneous coronary intervention is the preferred treatment in women with STEMI or non-STEMI who have risk factors, according to current guidelines [
8]. Bare metal stents are preferred over drug-eluting stents in pregnant women, because prolonged dual antiplatelet therapy is preferably avoided [
8,
9]. In stable patients with coronary artery dissection a more conservative approach has been advocated, since spontaneous healing often occurs and percutaneous coronary intervention is fraught with technical difficulties and a high failure rate [
10]. Medical treatment may include beta blockers and acetylsalicylic acid. Clopidogrel, though safe in animal studies, should be used with caution since experience in humans is limited. ACE-inhibitors and angiotensin receptor blockers are contra-indicated during pregnancy. Vaginal delivery is usually appropriate [
11]. Standard IHD risk factor management such as reducing smoking habits, obesity, hypertension and hypercholesterolaemia and treating lipoprotein disorders should be implemented. Additionally, antiphospholipid syndrome as a contributor to myocardial infarction in young women with a history of pregnancy morbidity such as spontaneous abortions, as observed in our first case, should be evaluated [
12].