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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 28  |  Issue : 1  |  Page : 45-46

Ventricular tachycardia in pregnancy causing maternal death


1 PGT, Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences, Imphal, Manipur, India
2 Assistant Professor, Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences, Imphal, Manipur, India
3 Associate Professor, Department of Cardiology, Regional Institute of Medical Sciences, Imphal, Manipur, India

Date of Web Publication24-Jun-2014

Correspondence Address:
Dr. R K Praneshwari Devi
Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences, Heirangoithong Bazar Singjamei, Imphal, Manipur - 795008
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4958.135234

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  Abstract 

Ventricular tachycardia (VT) is rarely observed during pregnancy. Its presence may indicate an underlying cardiac structural abnormality, or undiagnosed congenital arrhythmic disease. However, some pregnant women with VT have structurally normal hearts. There are few reports of new onset VT during pregnancy in absence of structural heart disease. We describe a case of ventricular tachycardia in pregnant woman with no previous heart disease. A 27-year-old, G2P0 + 0 + 1 + 0, at 39 weeks of gestation, presented with episodes of light headedness, vomiting, shortness of breath, and chest discomfort. There was cyanosis with respiratory rate of 56/min and heart rate of 136/min, regular. ECG showed multiple episodes of non-sustained VT with left bundle branch morphology, consistent with VT originating from the right ventricular outflow tract. Considering the diagnosis as VT, the patient was administered bolus doses of amiodarone, followed by maintenance dose. The condition worsened, and the patient expired within 1 hour of admission.

Keywords: Arrhythmias, Heart disease in pregnancy, Ventricular tachycardia in pregnancy


How to cite this article:
Vernekar MM, Praneshwari Devi R K, Singh TS, Tamang SP. Ventricular tachycardia in pregnancy causing maternal death. J Med Soc 2014;28:45-6

How to cite this URL:
Vernekar MM, Praneshwari Devi R K, Singh TS, Tamang SP. Ventricular tachycardia in pregnancy causing maternal death. J Med Soc [serial online] 2014 [cited 2020 Oct 25];28:45-6. Available from: https://www.jmedsoc.org/text.asp?2014/28/1/45/135234


  Introduction Top


Maternal cardiac ventricular tachycardia (VT) is rare. 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. We present a case of ventricular tachycardia in pregnant woman with no previous heart disease.


  Case Report Top


A 27-year-old woman, Gravida 2, Para 0, at 39 weeks of gestation, presented with episodes of light headedness, vomiting, shortness of breath, and chest tightness developing over the previous day. There were no other cardio-respiratory symptoms. Her pregnancy had been progressing normally and was asymptomatic.

She had no significant past medical history and had no complications relating to this pregnancy. The patient was using no medications except hematinic, calcium, and multivitamins. There was no history of smoking, alcohol consumption, or illicit drug use.

Physical examination revealed an afebrile patient with pulse and blood pressure non-recordable, cold and clammy extremities. There was cyanosis with respiratory rate of 56/min, heart rate of 136/min, regular rhythm. On abdominal examination, uterus corresponding to term size with fetus in cephalic presentation with absent fetal heart sound was found.

Laboratory investigations revealed normal complete blood count with hemoglobin 9 gm%. Other investigations like serum electrolytes, renal function test were within normal limits. ECG showed multiple episodes of monomorphic, non-sustained ventricular tachycardia (VT) with left bundle branch morphology, consistent with VT originating from the right ventricular outflow tract [Figure 1]. The clinical working diagnosis was pregnancy-related VT. The patient was administered bolus doses of intravenous amiodarone, followed by maintenance dose of intravenous amiodarone (150 mg) by the medicine consultation. Condition of the patient started worsening and within 1 hour of admission, the patient expired.
Figure 1: Electrocardiogram picture showing ventricular tachycardia

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  Discussion Top


Ventricular tachycardia (VT) may be seen in pregnancy and can be manifest as a new onset arrhythmia or be exacerbated by pregnancy and can cause concern for the well-being of both the mother and the fetus. Ventricular tachycardia may manifest at any time during pregnancy. [1]

Ventricular tachycardia is rarely observed during pregnancy. [2]

There are few reports of new onset VT during pregnancy in absence of structural heart disease. Increased sympathetic activity, as well as physiological changes associated with normal pregnancy is thought to be the most common precipitants of VT in pregnant women with a structurally normal hearts. [3]

Peripartum cardiomyopathy (PPCM) needs to be considered in women presenting with VT in the last month of pregnancy. [4]

In addition to cardiac diseases, several systemic non-cardiac disorders, including severe electrolyte derangements, thyroid function abnormalities, pulmonary embolism, anemia, and drug overdose may present with ventricular arrhythmias. [1]

Other conditions which may contribute to VT are hypomagnesaemia, hypertension, thyrotoxicosis, and long QT syndrome. Idiopathic VT during pregnancy usually originates from the right ventricular outflow tract. It has a good prognosis. [5]

For the ventricular tachycardia in pregnancy, if hemodynamics is stable and therapy is necessary, β-blockers are the drug of choice. If at any time VT becomes unstable or if there is evidence of fetal distress, electrical cardio version should be performed immediately. [6]


  Conclusion Top


Pregnant woman may present with ventricular tachycardia during any trimester. Careful and timely clinical, electrocardiographic, as well as echocardiographic assessment help identify those individuals with structural cardiac abnormalities who will need specific management. In those stable patients with structurally normal hearts, identification of the location of origin of tachycardia will help in choice of appropriate medical therapy.


  Acknowledgement Top


It is my great privilege on my part to express my sincere gratitude to Dr R. K. Praneshwari Devi, Assistant Professor, Dept. Obstetrics and Gynecology, RIMS, for her constant guidance while making this paper. I am also grateful to Dr Th. Sachin Deba Singh, Associate Professor, Dept. of Cardiology, RIMS, for his valuable support in the data.

 
  References Top

1.Kotchetkov R, Patel A, Salehian O. Ventricular Tachycardia in Pregnant Patients. Clin Med Insights Cardiol 2010;4:39-44.  Back to cited text no. 1
    
2.Trappe HJ. Emergency therapy of maternal and fetal arrhythmias during pregnancy. J Emerg Trauma Shock 2010;3:153-9.  Back to cited text no. 2
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3.Gowda RM, Khan IA, Mehta NJ, Vasavada BC, Sacchi TJ. Cardiac arrhythmias in pregnancy: Clinical and therapeutic considerations. Int J Cardiol 2003;88:129-33.  Back to cited text no. 3
    
4.Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet 2006;368:687-93.   Back to cited text no. 4
    
5.Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, et al. Guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the ACC/AHA/ESC Committee., Circulation 2006;114:385-484.  Back to cited text no. 5
    
6.Chamaidi A, Gatzoulishellenic MA. Heart Disease and Pregnancy. J Cardiol 2006;47:275-91.  Back to cited text no. 6
    


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Abstract
Introduction
Case Report
Discussion
Conclusion
Acknowledgement
References
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