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McGourty M, Skaritanov E, Kovell L, Wilkie G. Cardiac evaluation in pregnant patients with dyspnea and palpitations. Am J Obstet Gynecol MFM 2024; 6:101359. [PMID: 38552959 DOI: 10.1016/j.ajogmf.2024.101359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Symptoms of underlying cardiac disease in pregnancy can often be mistaken for common complaints because of normal physiological changes in pregnancy. Echocardiographic evaluation of patients with symptoms of palpitations and dyspnea can detect structural changes and identify high-risk features. OBJECTIVE This study aimed to examine transthoracic echocardiograms of perinatal individuals completed for palpitations or dyspnea to determine the frequency of identifying structural changes. STUDY DESIGN This was a retrospective cohort study of all perinatal individuals with a transthoracic echocardiogram at a single academic center between October 1, 2017, and May 1, 2022. The indication for the echocardiogram, demographics, and clinical characteristics were recorded. Transthoracic echocardiograms with any abnormal findings noted in the transthoracic echocardiogram report were reviewed and categorized into findings of congenital heart disease, valvular disease, pericardial effusion, evidence of ischemia or wall motion abnormalities, abnormal diastolic or systolic function, and other. RESULTS Of 539 transthoracic echocardiograms completed on 478 individuals who were pregnant or in the 12-week postpartum period, 96 (17.8%) had an indication of palpitations, and 32 (5.9%) had an indication of dyspnea. Abnormal findings were seen in 21.9% of patients with palpitations and in 34.4% of patients with dyspnea. In patients with palpitations who had abnormal findings, 33.3% had congenital heart disease; 33.3% had mild valvular disease, including mitral valve prolapse; 19.0% had a pericardial effusion; and 14.3% had evidence of ischemia or wall motion defects. Abnormal transthoracic echocardiogram findings in the dyspnea cohort included ischemia or wall motion defects (27.3%), mild valvular disease or mitral valve prolapse (36.4%), and abnormal systolic or diastolic function (36.4%). CONCLUSION Many of the transthoracic echocardiograms completed for patients with dyspnea or palpitations identified no structural abnormality; however, in 1 of 3 to 1 of 4 patients, underlying structural heart disease was identified. Although some of these abnormalities were unlikely to change delivery plans, such as mild valvular disease or small effusions, other abnormalities, such as ischemia, congenital abnormalities, and abnormal systolic or diastolic function, were likely to have implications for pregnancy and postpartum management.
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MESH Headings
- Humans
- Female
- Pregnancy
- Dyspnea/diagnosis
- Dyspnea/physiopathology
- Dyspnea/etiology
- Dyspnea/epidemiology
- Retrospective Studies
- Adult
- Echocardiography/methods
- Echocardiography/statistics & numerical data
- Pregnancy Complications, Cardiovascular/physiopathology
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/epidemiology
- Pericardial Effusion/diagnosis
- Pericardial Effusion/physiopathology
- Pericardial Effusion/epidemiology
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/epidemiology
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/epidemiology
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/physiopathology
- Heart Valve Diseases/epidemiology
- Heart Valve Diseases/complications
- Heart Diseases/diagnosis
- Heart Diseases/physiopathology
- Heart Diseases/epidemiology
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Affiliation(s)
- Marie McGourty
- University of Massachusetts Chan School of Medicine, Worcester, MA (BS McGourty and BS Skaritanov)
| | - Ekaterina Skaritanov
- University of Massachusetts Chan School of Medicine, Worcester, MA (BS McGourty and BS Skaritanov)
| | - Lara Kovell
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan School of Medicine, Worcester, MA (Dr Kovell)
| | - Gianna Wilkie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Chan School of Medicine, Worcester, MA (Dr Wilkie).
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Joglar JA, Kapa S, Saarel EV, Dubin AM, Gorenek B, Hameed AB, Lara de Melo S, Leal MA, Mondésert B, Pacheco LD, Robinson MR, Sarkozy A, Silversides CK, Spears D, Srinivas SK, Strasburger JF, Tedrow UB, Wright JM, Zelop CM, Zentner D. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm 2023; 20:e175-e264. [PMID: 37211147 DOI: 10.1016/j.hrthm.2023.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
This international multidisciplinary expert consensus statement is intended to provide comprehensive guidance that can be referenced at the point of care to cardiac electrophysiologists, cardiologists, and other health care professionals, on the management of cardiac arrhythmias in pregnant patients and in fetuses. This document covers general concepts related to arrhythmias, including both brady- and tachyarrhythmias, in both the patient and the fetus during pregnancy. Recommendations are provided for optimal approaches to diagnosis and evaluation of arrhythmias; selection of invasive and noninvasive options for treatment of arrhythmias; and disease- and patient-specific considerations when risk stratifying, diagnosing, and treating arrhythmias in pregnant patients and fetuses. Gaps in knowledge and new directions for future research are also identified.
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Affiliation(s)
- José A Joglar
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Elizabeth V Saarel
- St. Luke's Health System, Boise, Idaho, and Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | | | | - Luis D Pacheco
- The University of Texas Medical Branch at Galveston, Galveston, Texas
| | | | - Andrea Sarkozy
- University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | | | - Danna Spears
- University Health Network, Toronto, Ontario, Canada
| | - Sindhu K Srinivas
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Carolyn M Zelop
- The Valley Health System, Ridgewood, New Jersey; New York University Grossman School of Medicine, New York, New York
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Kamdem F, Nganou-Gnindjio CN, Ymele HK, Eboutibe POM, Djomou A, Léle ECB, Hamadou B, Mouliom S, Viché L, Ngoté H, Kenmegne C, Ebongue MSN, Djibrilla S, Essome H. Epidemiological features and mortality risk factors of peripartum cardiomyopathy in a group of Sub-Saharan African population. Ann Cardiol Angeiol (Paris) 2023; 72:101615. [PMID: 37348442 DOI: 10.1016/j.ancard.2023.101615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure occurring during pregnancy. Its prevalence seems more frequent in Africa but its epidemiological, clinical and evolutionary particularities remain unknown. This study aimed to evaluate the epidemiological features and mortality risk factors of PPCM. MATERIAL AND METHOD We conducted a retrospective cross-sectional study over 38 months (January 2018 to March 2021) in 3 hospitals in the city of Douala(Cameroon). We included all patients with heart failure between the last month of pregnancy and 5 months after delivery without an identified cause. Were excluded, files not containing data on echocardiography, patients with heart failure without dilation or with LVEF≥ 45% and patients with a history of heart disease of known aetiology. Chi² tests and binary logistic regression were used for data analysis; the survival curve according to Kaplan Meier was drawn for the evolution. The threshold of significance was set at 0.05. RESULTS A total of 2102 medical records of women with heart failure were searched. In these records, a total of 59 patients showed signs of peripartum heart failure and only 29 fulfilled the inclusion criteria. From a socio-demographic point of view, the average age was 29 ± 7 years and 51.7% of patients were over 30 years old. Among these patients, 79.3% of patients lived in urban areas and 10.3% of patients had a low socio-economic level. The hospital frequency of PPCM was 1.3%. Clinically, primiparous and pauciparous women were the most affected; the diagnosis was made after more than a month of progression in 65.5% of patients. Dyspnea was present in all patients. In addition, 89.7% of patients had a left ventricular end-diastolic diameter ≥ 62 m, 48.3 % had a left ventricular ejection fraction (LVEF) between 30% and 45%, and 51.7% had an LVEF < 30%. The associated mortality rate was 27.7%. The only prognostic factor independently associated with mortality was age < 30 years. CONCLUSION The frequency of PPCM is relatively low in Cameroonian urban settings. Moreover, its diagnosis is generally delayed and it induces high mortality. Its occurrence in a woman under the age of 30 is a factor of poor prognosis.
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Affiliation(s)
- Félicité Kamdem
- Department of Internal Medicine, Douala General Hospital, Cameroon; Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon
| | | | | | | | - Armel Djomou
- Department of Internal Medicine, Douala Laquintinie Hospital, Cameroon
| | | | - Ba Hamadou
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
| | - Sidick Mouliom
- Department of Internal Medicine, Douala General Hospital, Cameroon; Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon
| | - Lade Viché
- Department of Internal Medicine, Douala General Hospital, Cameroon; Faculty of Medicine and Biomedical Sciences, University of Garoua, Cameroon
| | - Henri Ngoté
- Department of Internal Medicine, Douala General Hospital, Cameroon
| | | | - Marie Solange Ndom Ebongue
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon; Department of Internal Medicine, Douala Laquintinie Hospital, Cameroon
| | - Siddikatou Djibrilla
- Department of Internal Medicine, Douala Laquintinie Hospital, Cameroon; Faculty of Health Sciences, University of Buea, Cameroon
| | - Henri Essome
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon; Department of Internal Medicine, Douala Laquintinie Hospital, Cameroon
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Mostafavi A, Feizian M, Fotook Kiaei SZ, Tabatabaei SA. Dyspnea in pregnancy might be related to the incomplete physiological adaptation of the heart. J Cardiovasc Thorac Res 2022; 14:228-233. [PMID: 36699561 PMCID: PMC9871158 DOI: 10.34172/jcvtr.2022.30539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 10/13/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction: Dyspnea is a common complaint in pregnant women with no cardiac and pulmonary diseases. We aimed to assess whether physiological dyspnea of pregnancy was correlated with subtle changes in ventricular systolic and diastolic function. Methods: This cross-sectional study enrolled 40 healthy pregnant women in their second and third trimesters with no complaints of dyspnea and 40 healthy pregnant women in the same trimesters with a complaint of dyspnea. Parameters of echocardiography were compared between the 2 groups. Results: Global left ventricular ejection fraction (59.65±6.44 and 58.49±4.95 P=0.418 in patients without and with dyspnea respectively), and global longitudinal strain were not significantly different (18.72±2.90 and 18.94±3.07, P=0.57 in the same order). Global circumferential strain (GCS) was lower in patients with dyspnea. (20.19±4.86 vs 22.61±4.69, P=0.03). Systolic volume (33.17±8.94 vs 32.63±8.09) and diastolic volume (80.75±18.73 vs 78.37±16.63) and left ventricular end-diastolic diameter (47.5±4.24 vs 46.23±3.21) were not different (P=0.784, 0.560 and 0.146 respectively). Left ventricular end-systolic diameter was significantly lower in the case group (32.52±4.66 vs 29.92±4.05, P=0.011). Left atrial area index in the patients with dyspnea was lower(8.13±1.42 vs 8.94±1.4, P=0.014). Other findings were a high E/E' and high pulmonary artery pressure in the patients with dyspnea. Conclusion: Dyspnea in pregnant women can be a consequence of incomplete physiological adaptation to volume overload in pregnancy. Lower systolic and diastolic diameters of the left ventricle, left atrial area, and left atrial index may lead to increased filling pressure, manifested by a higher E/E' ratio and pulmonary artery pressure.
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Affiliation(s)
- Atoosa Mostafavi
- Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Feizian
- Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Zahra Fotook Kiaei
- Advanced Thoracic research center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Seyed Abdolhussein Tabatabaei
- Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author: Seyed Abdol Hussein Tabatabaei,
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5
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Senarath S, Nanayakkara P, Beale AL, Watts M, Kaye DM, Nanayakkara S. Diagnosis and management of arrhythmias in pregnancy. Europace 2021; 24:1041-1051. [PMID: 34904149 DOI: 10.1093/europace/euab297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Arrhythmias are the most common cardiac complications occurring in pregnancy. Although the majority of palpitations in pregnancy may be explained by atrial or ventricular premature complexes, the full spectrum of arrhythmias can occur. In this article, we establish a systematic approach to the evaluation and management of arrhythmias in pregnancy. Haemodynamically unstable arrhythmias warrant urgent cardioversion. For mild cases of benign arrhythmia, treatment is usually not needed. Symptomatic but haemodynamically stable arrhythmic patients should first undergo a thorough evaluation to establish the type of arrhythmia and the presence or absence of structural heart disease. This will ultimately determine the necessity for treatment given the potential risks of anti-arrhythmic pharmacotherapy in pregnancy. We will discuss the main catalogue of anti-arrhythmic medications, which have some established evidence of safety in pregnancy. Based on our appraisal, we provide a treatment algorithm for the tachyarrhythmic pregnant patient.
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Affiliation(s)
- Sachintha Senarath
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
| | - Pavitra Nanayakkara
- Department of Obstetrics and Gynaecology, The Epworth Hospital, Richmond, Victoria, Australia
| | - Anna L Beale
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Cardiology, The Alfred, Melbourne, Victoria, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Monique Watts
- Department of Cardiology, The Alfred, Melbourne, Victoria, Australia
| | - David M Kaye
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Cardiology, The Alfred, Melbourne, Victoria, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Shane Nanayakkara
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Department of Cardiology, The Alfred, Melbourne, Victoria, Australia.,Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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6
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Motlagh AJ, Esmaelzadeh Saeieh S, Parhigar O, Salehi L. An asthmatic pregnant woman with COVID-19: A case report study. Respir Med Case Rep 2020; 31:101296. [PMID: 33240787 PMCID: PMC7676370 DOI: 10.1016/j.rmcr.2020.101296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/12/2020] [Accepted: 11/16/2020] [Indexed: 12/27/2022] Open
Abstract
Background COVID-19 represents with various clinical symptoms and infects the respiratory tract, throat, nose, and lung involvement can lead to severe lung disease and death., among asthmatic patients, infections can lead to deterioration. The severity, and prognosis of this disease are likely to be devasted in pregnant women with underlying diseases such as asthma. Case presentation We present an Asthmatic pregnant woman who infected with SARS-CoV-2 admitted to two hospitals in Iran. The patient's symptoms were dry coughs, dyspnea, and inability to speak, numbness, and fatigue. The initial examination indicated a body temperature of 37.9 °C, oxygen saturation (SPO2) 91%, partial pressure of oxygen (Pao2) was 25 mm Hg, respiratory rate (RR) of 20 breaths/minute (b/m), blood pressure of 100/60 mmHg, and pulse of 80 bpm (beat/minute) and fetal heart rate (FHR) = 167/min. The pregnancy terminated by Caesarean Section (C/S) due to fetal tachycardia, a healthy baby with normal range. Anthropometric characteristics were born. Our case had leukopenia and also revealed, elevated C-reactive protein and erythrocyte sedimentation rate. Our case received supportive care and antibiotic & antiviral therapy and was discharged within 8 days with a good general condition. Conclusions The patient's condition improved after 8 days of hospitalization and the patient underwent appropriate clinical outcome in spite of underlying disease and infection with SARS-CoV-2
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Key Words
- ARDS, Acute Respiratory Distress Syndrome
- Asthma
- BMI, Body Mass Index
- C/S, Caesarean Section
- COVID-19
- CT, Computed Tomography
- Case report
- ESR, Erythrocyte Sedimentation Rate
- FHR, Fetal Heart Rate
- IP, Interstitial Pneumonia
- Iran
- NPO, Non-Per Oral
- NST, Non-Stress Test
- PROM, Premature Rapture of Membrane
- PaO2, Partial Pressure of Oxygen
- Pregnancy
- RR, Respiratory Rate
- RT-PCR, Reverse Transcription Poly Mearas Chain
- SARA, Severe Acute Respiratory Syndrome
- SPo2, Percentage of Oxygen Saturation
- bpm, beat per minute
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Affiliation(s)
- Alireza Jashni Motlagh
- Department of Pediatrics, School of Medicine, Imam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Sara Esmaelzadeh Saeieh
- Department of Midwifery, School of Medicine, Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Ozra Parhigar
- MS, Midwifery ward, Imam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Leili Salehi
- Research center for Health, Safety and Environment, Department of Health Education & Promotion, Alborz University of Medical Sciences, Karaj, Iran
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7
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Physiological Changes and Cardiovascular Investigations in Pregnancy. Heart Lung Circ 2020; 30:e6-e15. [PMID: 33158736 DOI: 10.1016/j.hlc.2020.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 09/22/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023]
Abstract
Profound physiological changes in the maternal cardiovascular system occur shortly after conception. These changes may impact upon the investigation of healthy and complicated pregnancies. Additionally, concerns regarding fetal exposure to ionising radiation are important considerations in maternal testing. This manuscript reviews the important physiological changes pertinent to the investigation of maternal cardiovascular disease in pregnancy.
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8
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Georgiopoulos G, Tsiachris D, Kordalis A, Kontogiannis C, Spartalis M, Pietri P, Magkas N, Stefanadis C. Pharmacotherapeutic strategies for atrial fibrillation in pregnancy. Expert Opin Pharmacother 2019; 20:1625-1636. [PMID: 31136204 DOI: 10.1080/14656566.2019.1621290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Georgios Georgiopoulos
- Department of Cardiology, Athens Medical Center, Athens, Greece
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Christos Kontogiannis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Spartalis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Nikolaos Magkas
- 1stDepartment of Cardiology, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
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9
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Metz TD, Khanna A. Evaluation and Management of Maternal Cardiac Arrhythmias. Obstet Gynecol Clin North Am 2016; 43:729-745. [PMID: 27816157 DOI: 10.1016/j.ogc.2016.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pregnant women often complain of palpitations. The differential diagnosis for new-onset palpitations in pregnancy ranges from benign conditions to life-threatening arrhythmias. Maternal arrhythmias can occur in isolation or in the setting of underlying structural heart disease. Optimal management of maternal cardiac arrhythmias includes identification of the specific arrhythmia, diagnosis of comorbid conditions, and appropriate intervention. In general, management of maternal cardiac arrhythmias is similar to that of the general population. Special consideration must be given as to the effects of medications and procedures on both the mother and fetus to optimize outcomes. The importance of multidisciplinary care with cardiology, obstetrics, and anesthesia is emphasized.
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Affiliation(s)
- Torri D Metz
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, USA; Department of Obstetrics and Gynecology, Denver Health Medical Center, 777 Bannock Street, MC 0660, Denver, CO 80204, USA.
| | - Amber Khanna
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, Aurora, CO 80045, USA
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10
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Tara F, Vakilian F, Moosavi-Baigy F, Salehi M, Moghiman T. Prenatal and cardiovascular outcome in pregnant patients with dyspnea. Res Cardiovasc Med 2015; 4:e20950. [PMID: 25861584 PMCID: PMC4386424 DOI: 10.5812/cardiovascmed.20950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/10/2014] [Accepted: 11/05/2014] [Indexed: 11/28/2022] Open
Abstract
Background: Pregnancy is a physiologic phenomenon in women, which leads to significant hemodynamic changes in cardiovascular system. Many patients reach reproductive age due to improvements in diagnosis and treatment of cardiac diseases. Dyspnea is a common complaint in pregnant women and can be a sign to refer patients for an easy and feasible workup such as echocardiography. Objectives: We aimed to evaluate dyspnea as a common complaint in pregnant women and its prenatal outcome. Patients and Methods: Pregnant patients with dyspnea NYHA class > II were included. A thorough physical examination and routine lab tests were performed. Echocardiography was performed to rule out previous cardiac and lung diseases, anemia and thyroid disorders. It was repeated monthly till one month after delivery. Collected data was analyzed after one year. Results: Fifty patients were enrolled with a mean age of 30.49 ± 6.34 years. 58% of them, had NYHA class II, 40% III and 2% IV. Pulmonary rales were diagnosed in 8% and palpitation in 80%, while all had normal lab tests. Mean EF value was 52.26 ± 6.80; 54% had valvular diseases and 12% had pulmonary hypertension. Cesarean section was performed in 26, preeclampsia occurred in 7 and 21 had preterm labor. Three neonates had anomalies and six had an Apgar score below six. Mean birth weight was 2897 ± 540.00 grams. A significant association was found between NYHA Class with valvular disease (P = 0.007) and sys PAP (P = 0.036); however, it had an inverse correlation with LV EF (P = 0.06). Conclusions: Dyspnea may coincide with cardiac dysfunction and poor prenatal outcome in pregnant patients. In such cases echocardiography is a feasible screening tool.
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Affiliation(s)
- Fateme Tara
- Women Health Research Center, Omolbanin Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Farveh Vakilian
- Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Farveh Vakilian, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-9153162670, Fax: +98-5118544504, E-mail:
| | | | - Maryam Salehi
- Community Medicine Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Toktam Moghiman
- Atherosclerosis Prevention Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Abstract
BACKGROUND Venous thromboembolic disease is among the most common causes of morbidity and mortality during pregnancy. The clinical evaluation alone is insufficient for the diagnosis of venous thromboembolic disease, and the normal pregnant state makes this evaluation even more challenging. DIAGNOSIS Objective testing is the mainstay of diagnosis, including compression ultrasound, impedance plethysmography, ventilation-perfusion scanning, computed tomography scanning, and pulmonary angiography. All of these tests can be safety performed during pregnancy. TREATMENT If deep vein thrombosis or pulmonary embolism is diagnosed, anticoagulation should be initiated. Either (unfractionated) heparin or low molecular weight heparin is an acceptable treatment for acute venous thromboembolic disease. Both have risks and benefits, but both can be used safely during pregnancy. Intravenous heparin is the treatment of choice surrounding delivery due to its short half life. Because of the risk of adverse effects on the fetus, warfarin is not generally used during pregnancy. Unstable pulmonary embolism is difficult to treat during pregnancy, as there are minimal data regarding the safety and efficacy of thrombolytic therapy, inferior vena cava filters, and embolectomy during pregnancy. Case reports and case series suggest that thrombolytic therapy may be associated with lower risks of fetal loss than embolectomy. CONCLUSIONS Venous thromboembolic disease is a significant cause of morbidity and mortality during pregnancy and the puerperal period. Objective testing is critical to establish the diagnosis and can be safely performed during pregnancy. Anticoagulation with heparin is the mainstay of therapy during the pregnancy, but patients may be transitioned to warfarin after delivery.
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Affiliation(s)
- Sarah E Stone
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
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12
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Abstract
Pulmonary embolism is a significant cause of morbidity and mortality during pregnancy and the puerperium. The spectrum of venous thromboembolism is difficult to diagnose. Objective diagnostic testing is crucial and should not be delayed. Anticoagulation is the mainstay of therapy for deep vein thrombosis and pulmonary embolism. Most of the literature and practice protocols for the treatment of pregnant women are based on data extrapolated from the nonpregnant population, and more research is needed to improve the understanding of the efficacy and safety of testing and therapy in the pregnant population.
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Affiliation(s)
- Sarah E Stone
- Department of Medicine, University of California, San Diego, 200 West Arbor Drive, San Diego, CA 92103-8378, USA
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