New year – new life for mother and her baby daughter: Tamar Malol, 24 years old from Jerusalem, was in the middle of a family event when her heart attacked her. Without any previous sign, when she was carrying a healthy fetus in her womb, she began to suffer from a sharp pain in her chest and right hand.
When the symptoms did not stop, her frightened family members called the Magen David Adom team, which arrived urgently at the scene. Tests raised a suspicion of a heart attack and she was referred in an intensive care unit to Shaare Zedek Medical Center.
When she arrived at the emergency department, Tamar was already in the midst of a heart attack and her condition was deteriorating. She was rushed to the cardiac intensive care unit at Shaare Zedek Medical Center, under the direction of Dr. Elad Asher – there, obstetrician specialists from the Women’s and Obstetrics Division, under the direction of Prof. Sorina Grisero, and specialists from the Neonatal Department, headed by Dr. Yaron Neve, and the Pregiya, headed by Dr. Rabbi Alona ben Nun.
“It happened at noon,” Tamar tells her story. “When we sat down for a family meal, I started to feel like stabbings and pain, I thought I had caught a muscle from the air conditioner because it was cool, but the pain in the chest area only got worse, to which was also added the hand that started to hurt, an unbearable pain.
“When the paramedic team arrived, I started vomiting and I felt like I couldn’t breathe, I asked them to move away from me. Initially, because of my young age and the vomiting, poisoning was suspected, but to be sure, an EKG test was performed. which presented an abnormal finding. From there I was flown to Shaare Zedek.
“I didn’t ask questions so as not to stress myself. I think I lost consciousness from the pain. When I woke up in the cardiac intensive care unit, I was told about the heart attack and the options for treatment. I didn’t think about anything, I just knew that I wanted to survive for the baby.
“After a diagnostic catheterization, they saw that there was a blood clot and left me for close observation in the cardiac intensive care unit. There were lots of tests every day and I needed many medicines. The doctors and nurses with endless dedication did everything to take care of me and the fetus.”
Dr. Elad Asher, who treated the case and accompanied Tamar throughout the treatment, explains: “Treatment of this condition during pregnancy (or immediately after) is much more complex due to the use of radiation in the catheter, the use of various drugs to thin the blood and lower cholesterol, and others, which can harm or interfere with the fetus while breastfeeding Tamar was admitted with a heart attack, pregnant and with very low blood platelets, which made it difficult to provide both catheter and drug treatment for fear of bleeding and risking the life of the fetus.
“A heart attack (myocardial infarction) in women under the age of 40 is relatively rare, therefore also in pregnant women in several studies it was found that the incidence is between 2.4-6.2 cases per 100,000 pregnancies. Another study found that a myocardial infarction occurred in 1 out of every 12,400 women hospitalized during pregnancy, with over 50% of the infarctions occurring after delivery.
“After about a month and a half of intensive treatment, in the middle of the night – due to the development of labor, the teams of the women’s wing were called to give birth to Tamar in collaboration with the team of obstetric anesthesiologists led by Prof. Alex Yoskovitz and his team, under the dedicated supervision of the team of cardiologists.
Dr. Chen Sela, director of the fourth maternity department at Shaare Zedek Medical Center, who gave birth to Tamar by caesarean section, says that the obstetric challenge was to treat Tamar and make sure that the fetus feels well, to try to prevent a premature birth and to avoid emergency birth or surgery during the period when the mother She is still not stable from a cardiac point of view. “Fortunately, the cardiologists, in conjunction with the hematologist Dr. Ariela Toito, were able to stabilize Tamar so that several weeks passed from the time she arrived with the acute cardiac event until the moment of birth, which arrived safely on time for Tamar and her daughter.”
Dr. Elad Asher: “Fortunately, Tamar went through the event and the birth “smoothly” and now she is slowly returning to normal life, the blood platelets returned to normal after the birth and she will be able to return to normal life and function fully as a mother.”
Prof. Sorina Grisero: “Coronary artery disease and a cardiac ischemic event are rare in pregnancy, in healthy young women without sclerotic disease of the coronary arteries. The cause of a cardiac event during pregnancy is usually a dissection of a coronary artery or a thrombus (blood clot) or both events together. The cause of this is unknown, but the researchers speculate that it is a genetic predisposition, which together with excessive coagulability during pregnancy and sometimes dehydration combine to form a blockage of a coronary artery. Early diagnosis and conservative monitoring can help in prevention.
The key to success is multidisciplinary care and accurate planning of the birth and appropriate anesthesia. The preparedness at any moment of all the doctors involved allowed monitoring and risk assessment for the mother and the fetus at any given moment until and after the birth.”
After an audit in the intensive care department Lev Tamar was transferred to the maternity ward. After several days of hospitalization and checks, Tamar was released to Beitan and her home is in good condition.
Tamar concluded: “It’s a great miracle. God gave me the strength to cope and sent good messengers, the doctors and nurses who throughout the hospitalization did everything so that I would leave here with my hands full and in perfect health. I am happy to start a new year when I received my life and the life of my daughter as a gift.”