Case Report

Myocardial Infarction and Oral Contraceptives

Authors: A. S. WARDEKAR MD, B. S. SON MD, B. A. BERCU MD

Abstract

It has been established that oral contraceptives play a significant role in the causation of thromboembolic disorders in women.1 The risk of admission for venous ihroraboentbolism is 9 times higher in women on oral contraceptives than those who are not.1 “The preliminary results of the investigation by the Committee on Safety of Drugs estimated the risk of death from thrombo-embolism among women on oral contraceptives to be in excess of 3 deaths per 100,000 women per year over the corresponding mortality in nonusers.“The use of oral contraceptives and mortality from pulmonary embolism or cerebral thrombosis shows a strong correlation. Death from these 2 diseases attributable to the use of oral contraceptives by healthy women was estimated to be 1.3 per 100,000 users aged 20 to 34 and 3.4 per 100,000 users aged 35 to 44 per annum. When the deaths from coronary thrombosis were included in the above estimates of attributable mortality, the recalculated figures showed 2.2 and 4.5 deaths per 100,000 users per annum for women aged 20 to 34 years and 35 to 44 years respectively.”Although occurrence of isolated arterial thrombosis (popliteal, middle cerebral, vertebral, internal carotid and superior mesenteric arteries) in users of oral contraceptives has been documented,2 a definite relationship between the use of oral contraceptives and coronary thrombosis has not been completely resolved.Vessey and Doll1,3 found no definite correlation between the use of oral contraceptives and coronary thrombosis. Boyce and associates4 reported a 32 year old woman and Naysmiths a 33 year old woman who had a myocardial infarction while on oral contraceptive pills.In a recent review of 22 cases of myocardial infarction in women less than 41 years of age, it was concluded that oral contraceptives do not appear on their own to increase the risk of developing myocardial infarction, but they may do so in women otherwise prone to ischemic heart disease.6A Danish survey of 14 cases also showed some correlation between the use of oral contraceptives and the development of myocardial infarction.7Dalgaard and Gregersen,8 in 1969, encountered (out of 169 medicolegal autopsies) 5 instances of fatal thromboembolism in women aged 20 to 38 years taking oral contraceptive pills and 4 of these 5 women died of coronary thrombosis. All of them had occlusion of the anterior descending branch of the left coronary artery.Davis and co-workers9 recently reported 2 cases of myocardial infarction documented by ERG and coronary arteriogram in a 27 year old and a 37 year old woman on oral contraceptives. Both had occlusion of the anterior descending branch of the left coronary artery.The case report is of a 29 year old white woman who had an acute myocardial infarction while on an oral contraceptive (Ortho 2) and was found to have no other predisposing factor to its development.

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References