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Clark KJ, Arendt KW, Rehfeldt KH, Sviggum HP, Kauss ML, Ammash NM, Rose CH, Sharpe EE. Peripartum anesthetic management in patients with left ventricular noncompaction: a case series and review of the literature. Int J Obstet Anesth 2022; 52:103575. [PMID: 35905687 DOI: 10.1016/j.ijoa.2022.103575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 06/18/2022] [Accepted: 06/29/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND This retrospective review focuses on peripartum anesthetic management and outcome of a series of five pregnant women with left ventricular noncompaction (LVNC). METHODS The Mayo Clinic Advanced Cohort Explorer medical database was utilized to identify women diagnosed with LVNC who had been admitted for delivery at the Mayo Clinic in Rochester, Minnesota between January 2001 and September 2021. Echocardiograms were independently reviewed by two board-certified echocardiographers, and those determined by both to meet the Jenni criteria and/or having compatible findings on magnetic resonance imaging (MRI) were included. Electronic medical records were reviewed for information pertaining to cardiac function, labor, delivery, and postpartum management. RESULTS We identified 44 patients whose medical record included the term "noncompaction" or "hypertrabeculation" and who had delivered at our institution during the study period. Upon detailed review of the medical records, 36 did not meet criteria for LVNC, and three additional patients did not receive the diagnosis until after delivery, leaving five patients with confirmed LVNC who had undergone six deliveries during the study interval. All five patients had a history of arrhythmias or had developed arrhythmias during pregnancy. One patient underwent emergency cesarean delivery due to sustained ventricular tachycardia requiring three intra-operative cardioversions. CONCLUSIONS This case series adds new evidence to that already available about pregnancies among women with LVNC. Favorable obstetrical outcomes were achievable when multidisciplinary teams were prepared to manage the maternal and fetal consequences of intrapartum cardiac arrhythmias and hemodynamic instability.
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Affiliation(s)
- K J Clark
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - K W Arendt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - K H Rehfeldt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - H P Sviggum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - M L Kauss
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - N M Ammash
- Department of Cardiovascular Disease, Sheikh Shakhbout Medical City in Partnership with Mayo Clinic, Ghweifast International Highway, Abu Dhabi, United Arab Emirates
| | - C H Rose
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mayo Clinic, Rochester, MN, USA
| | - E E Sharpe
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
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Ibetoh CN, Stratulat E, Liu F, Wuni GY, Bahuva R, Shafiq MA, Gattas BS, Gordon DK. Supraventricular Tachycardia in Pregnancy: Gestational and Labor Differences in Treatment. Cureus 2021; 13:e18479. [PMID: 34659918 PMCID: PMC8494174 DOI: 10.7759/cureus.18479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022] Open
Abstract
Supraventricular tachycardia (SVT) is a tachyarrhythmia characterized by a heart rate above 120 beats per minute (BPM). Patients with SVT exhibit the following symptoms: palpitations, shortness of breath, chest pain, hemodynamic instability, or possibly asymptomatic. The increase in cardiac output and the increase in resting heart rate during pregnancy predispose pregnant women to SVT. The management of SVT in pregnancy, although remarkably similar, varies slightly based on the trimester of pregnancy. Atenolol and verapamil are effective methods of treating SVT, which can be used during the second and third trimesters. Both medications are contraindicated in the first trimester. At the same time, intravenous adenosine can be used in all three trimesters, including labor. Electrical cardioversion is an effective treatment method for hemodynamically unstable or drug-refractory patients, which has proven to be safe in all three trimesters, including labor but can result in pre-term labor in the third trimester. Non-fluoroscopic ablation proved to be the only treatment method that definitively resolved SVT without recurrence.
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Affiliation(s)
- Crystal N Ibetoh
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Eugeniu Stratulat
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Fan Liu
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - George Y Wuni
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ronak Bahuva
- Internal Medicine, California Institute of Behavioral Neuroscience & Psychology, Fairfield, USA
- Internal Medicine, University at Buffalo, Buffalo, USA
| | - Muhammad A Shafiq
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Rawalpindi Medical University, Islamabad, PAK
| | - Boula S Gattas
- Internal Medicine, California Institute of Behavioral Neuroscience & Psychology, Fairfield, USA
| | - Domonick K Gordon
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Scarborough General Hospital, Scarborough, TTO
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Mehta LS, Warnes CA, Bradley E, Burton T, Economy K, Mehran R, Safdar B, Sharma G, Wood M, Valente AM, Volgman AS. Cardiovascular Considerations in Caring for Pregnant Patients: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e884-e903. [DOI: 10.1161/cir.0000000000000772] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardio-obstetrics has emerged as an important multidisciplinary field that requires a team approach to the management of cardiovascular disease during pregnancy. Cardiac conditions during pregnancy include hypertensive disorders, hypercholesterolemia, myocardial infarction, cardiomyopathies, arrhythmias, valvular disease, thromboembolic disease, aortic disease, and cerebrovascular diseases. Cardiovascular disease is the primary cause of pregnancy-related mortality in the United States. Advancing maternal age and preexisting comorbid conditions have contributed to the increased rates of maternal mortality. Preconception counseling by the multidisciplinary cardio-obstetrics team is essential for women with preexistent cardiac conditions or history of preeclampsia. Early involvement of the cardio-obstetrics team is critical to prevent maternal morbidity and mortality during the length of the pregnancy and 1 year postpartum. A general understanding of cardiovascular disease during pregnancy should be a core knowledge area for all cardiovascular and primary care clinicians. This scientific statement provides an overview of the diagnosis and management of cardiovascular disease during pregnancy.
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Kochhar PK, Ghosh P. Ventricular tachycardia in a primigravida with Hyperemesis Gravidarum. J Obstet Gynaecol Res 2018; 44:1308-1312. [PMID: 29687933 DOI: 10.1111/jog.13651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/03/2018] [Indexed: 11/29/2022]
Abstract
Hyperemesis gravidarum is persistent vomiting, seen more often in the first trimester of pregnancy, when the patient is unable to maintain adequate hydration. Intractable vomiting can lead to severe electrolyte imbalance, which may cause electrocardiogram abnormalities. Occasionally, ventricular tachycardia can complicate a pregnancy. Although its occurrence usually indicates an underlying cardiac structural or arrhythmic abnormality, it may rarely occur in a pregnant patient with structurally normal heart. We report a rare case of ventricular tachycardia, secondary to hyperemesis induced hypomagnesemia and hypokalemia, in a pregnant patient with a structurally normal heart.
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Comorbidities in obstetric anesthesia. Int Anesthesiol Clin 2014; 52:110-31. [PMID: 24946046 DOI: 10.1097/aia.0000000000000020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moodley S, Sanatani S, Potts JE, Sandor GGS. Postnatal outcome in patients with fetal tachycardia. Pediatr Cardiol 2013; 34:81-7. [PMID: 22639009 DOI: 10.1007/s00246-012-0392-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 05/09/2012] [Indexed: 10/28/2022]
Abstract
The diagnosis and management of prenatal tachyarrhythmias is well established; however, the postnatal course and outcomes are not. The purpose of our study was to review the natural history of patients with fetal tachycardia, determine the incidence of postnatal arrhythmias, and determine whether there are factors to predict which fetuses will develop postnatal arrhythmias. A retrospective chart review of patients with fetal tachyarrhythmias investigated at British Columbia Children's and Women's Hospitals between 1983 and 2010 was conducted. Sixty-nine mother-fetus pairs were eligible for the study. Fifty-two had fetal supraventricular tachycardia, and 17 had fetal atrial flutter. Conversion to sinus rhythm occurred prenatally in 52 % of patients. Postnatal arrhythmia occurred in two thirds of patients, with 82 % of those cases occurring within the first 48 h of life. Hydrops fetalis, female sex, and lack of conversion to sinus rhythm was predictive of postnatal arrhythmia (P = 0.01, P = 0.01, and P = 0.001, respectively). Conversion to sinus rhythm prenatally did not predict postnatal arrhythmia. Median duration of treatment was 9 months. Two postnatal deaths of unknown etiology occurred. Two thirds of all patients with prenatal tachycardia will develop postnatal arrhythmia. Prenatal factors that predict postnatal arrhythmia include hydrops, sex, and whether or not conversion to sinus rhythm occurred prenatally. The majority of patients with postnatal arrhythmia present within 48 h of life, which has clinical implications for monitoring. Postnatal outcome is generally very good with most patients being weaned off medication in 6-12 months.
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Affiliation(s)
- Shreya Moodley
- Division of Pediatric Cardiology, British Columbia Children's Hospital and The University of British Columbia, Vancouver, BC V6H 3V4, Canada
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Yılmaz F, Beydilli I, Kavalcı C, Yılmaz S. Successful electrical cardioversion of supraventricular tachycardia in a pregnant patient. AMERICAN JOURNAL OF CASE REPORTS 2012; 13:33-5. [PMID: 23569481 PMCID: PMC3615988 DOI: 10.12659/ajcr.882594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 02/07/2012] [Indexed: 12/05/2022]
Abstract
Background: Pregnancy can precipitate cardiac arrhythmias not previously present in seemingly well individuals. Atrial and ventricular premature beats are frequently present during pregnancy and are usually benign. Supraventricular tachycardia and malignant ventricular tachyarrhythmias occur less frequently. Maternal and fetal arrhythmias occurring during pregnancy may jeopardize the life of the mother and the fetus. Case Report: A 32-year-old pregnant women at 26 weeks gestation presented to the emergency department with palpitation. She had mild chest discomfort after a supraventricular tachycardia (SVT) episode but did not have syncope. After monitoring and access of an IV line, vagal manoeuvres were applied but the rhythm was resistant. Then she was treated with 5 mg metoprolol IV, but the SVT persisted. Then after IV infusion of adenosine triphosphate 6 to 12 mg, the rhythm was resistant. Synchronized cardioversion with 100 joules was performed. Patients’ rhythm was normalized to a sinus rhythm. She was discharged from hospital without any adverse effects following 24-hour monitoring. Conclusions: All pregnant patients with SVT require careful maternal and fetal monitoring during treatment, and close collaboration between the managing obstetrician and the cardiologist is essential.
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Affiliation(s)
- Fevzi Yılmaz
- Numune Research and Training Hospital, Department of Emergency, Ankara, Turkey
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Wolff GA, Weitzel NS. Management of acquired cardiac disease in the obstetric patient. Semin Cardiothorac Vasc Anesth 2011; 15:85-97. [PMID: 21994133 DOI: 10.1177/1089253211420302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Physiologic changes incurred by pregnancy can cause severe decompensation in the parturient with underlying cardiac disease. The result is increased morbidity and mortality for both mother and child. Appropriate anesthetic management can significantly impact these outcomes. This review systematically presents the pathophysiology, peripartum risk, and anesthetic management in the puerperium of specific acquired cardiac abnormalities including: valvular disease, pulmonary hypertension, cardiomyopathy, cardiac transplantation, ischemia, arrhythmias, and cardiac arrest.
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Canlorbe G, Azria E, Michel D, Iung B, Mahieu-Caputo D. Menace d’accouchement prématuré après administration d’adénosine pour la réduction d’une tachycardie supraventriculaire paroxystique à 30 semaines d’aménorrhée : à propos d’un cas. ACTA ACUST UNITED AC 2011; 30:372-4. [DOI: 10.1016/j.annfar.2011.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 02/04/2011] [Indexed: 11/16/2022]
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Abstract
Two pregnant patients with a sustained symptomatic maternal supraventricular arrhythmia are presented. Both patients were treated with direct-current cardioversion. Electrical cardioversion during pregnancy is a rarely applied but highly effective procedure in the treatment of maternal cardiac arrhythmias and is assumed safe for both mother and child. However, once foetal viability is reached, monitoring of the foetal heart rate is advised and facilities for immediate caesarean section should be available.
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Abstract
Ventricular tachycardia although not common, can occasionally complicate pregnancy. Its presence may indicate an underlying cardiac structural abnormality, or undiagnosed congenital arrhythmic disease. However, some pregnant patients with ventricular tachycardia have structurally normal hearts. Two cases of ventricular tachycardia in pregnant patients with structurally normal hearts are presented and an approach to diagnosis and management of such patients are discussed.
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Biria M, Bommana S, Kroll M, Panescu D, Lakkireddy D. Multi-organ effects of Conducted Electrical Weapons (CEW) -- a review. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:1266-1270. [PMID: 21095915 DOI: 10.1109/iembs.2010.5626415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Since the introduction of the Conducted Electrical Weapons (CEW) several studies have been conducted and multiple reports have been published on safety of these devices from a medical point of view. Use of these devices in different situations and reported deaths attracts media attention and causes general anxiety around these devices. These devices have several limitations- such as rate of fire or maximum effective range in comparison to fire arms. Here we wish to review medical publications regarding the safety of these devices based on different systems.
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Affiliation(s)
- Mazda Biria
- University of Kansas Hospital, Kansas City, Kansas, USA
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Ferrer L, Garlón D. Manejo de paciente obstétrica a término con fibrilación auricular con respuesta ventricular rápida sin inestabilidad hemodinámia. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2009. [DOI: 10.1016/s0120-3347(09)71011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Murphy J, Slodzinski M. Right ventricular outflow tract tachycardia in the parturient. Int J Obstet Anesth 2008; 17:275-8. [PMID: 18511258 DOI: 10.1016/j.ijoa.2007.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 09/01/2007] [Indexed: 10/22/2022]
Abstract
Parturition is marked by physiological changes that may elicit electrocardiographic anomalies. Sustained right ventricular tachycardia is an uncommon arrhythmia that necessitates cardioversion using physical, pharmaceutical or electrical means. Patients with right ventricular tachycardia must be evaluated for right ventricular dysplasia. Long-term management of right ventricular tachycardia includes beta-adrenergic blockade and/or radio ablation of right ventricle outflow region usually below the pulmonary annuls. This report discusses the case of a 28-year-old previously healthy primigravid who experienced right ventricular outflow tract tachycardia during labor.
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Affiliation(s)
- J Murphy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA
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Trappe H, Tchirikov M. Herzrhythmusstörungen bei der Schwangeren und beim Fetus. Internist (Berl) 2008; 49:788-98. [DOI: 10.1007/s00108-008-2072-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Increasing numbers of women with complex congenital heart disease are reaching childbearing age. Pregnancy is a major issue in the management of adult congenital heart disease. Cardiac disease is one of the most common causes of maternal morbidity and mortality. Complications, such as growth retardation, preterm and premature birth and even fetal and neonatal mortality, are more frequent among children of women with congenital heart disease. The risk of complications is determined by the severity of the cardiac lesion, the presence of cyanosis, the maternal functional class and the use of anticoagulation. However, the pathophysiology of these complications is not completely understood and may be related to a diminished increase in cardiac output and/or endothelial dysfunction. The management of pregnant cardiac patients is based on limited clinical information. This article reviews pre-pregnancy counseling and management during pregnancy in patients with congenital heart disease.
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Affiliation(s)
- Yusuf Karamermer
- Erasmus MC, Department of Cardiology, Room Ba308, s-Gravendijkwal 230, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Drake E, Preston R, Douglas J. Brief review: anesthetic implications of long QT syndrome in pregnancy. Can J Anaesth 2007; 54:561-72. [PMID: 17602043 DOI: 10.1007/bf03022321] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To review the effects of the long QT syndrome (LQTS) in the parturient and the current anesthetic management of patients with LQTS. SOURCE Relevant articles were obtained from a MEDLINE search spanning the years 1980-2006 and a PubMed search spanning the years 1949-2006. Bibliographies of retrieved articles were searched for additional articles. PRINCIPAL FINDINGS The prevalence of LQTS in the developed world is one per 1,100 to 3,000 of the population. Clinically, LQTS is characterized by syncope, cardiac arrest and occasionally, by a history of seizures. The QT interval can also be prolonged by drugs, electrolyte imbalances, toxins and certain medical conditions. Long QT syndrome patients are at risk of torsades de pointes and ventricular fibrillation. Medical management aims to reduce dysrhythmia frequency. The LQTS is subdivided into different groups (LQT1-6) depending on the cardiac ion channel abnormality. Torsades can be precipitated by adrenergic stimuli such as stress or pain (LQT1 and 2), sudden noises (LQT2) or whilst sleeping (LQT3). Patients with LQTS require careful anesthetic management as they are at high risk of torsades perioperatively despite minimal data on the effects of anesthetic agents on the QT interval. While information on effects of LQTS in pregnancy is limited, the incidence of dysrhythmia increases postpartum. Isolated case reports of patients with LQTS women highlight several peripartum dysrhythmias. CONCLUSION An understanding of LQTS and the associated risk factors contributing to dysrhythmias is important for anesthesthesiologists caring for parturients with LQTS.
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Affiliation(s)
- Elizabeth Drake
- Department of Anesthesia, BC Women's Hospital, Vancouver, British Columbia V6H 3N1, Canada.
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