Study record managers: refer to the Data Element Definitions if submitting registration or results information. This is a non-interventional, physiological study which will explore the feasibility of examining autonomic function and related haemodynamic variables in pregnant women with and without inappropriate sinus tachycardia, with the aim of providing scope for future research. Sinus tachycardia normal heart rhythm but fast heart rate is common and usually related to an obvious cause e. In rare cases however, sinus tachycardia can occur without an obvious cause i. This syndrome of inappropriate sinus tachycardia is poorly understood and can be difficult to manage; especially when the affected individual is pregnant.
In: Long WA ed. Login or register to Sinus tachycardia during pregnancy PDF. However, many of the currently available AADs have proarrhythmogenic effects and could even increase mortality. Order reprints. Currently, foetal echocardiography is the best method and remains the durinv for in utero diagnosis of arrhythmias. Eligibility Criteria. It has been known for a long time that in emergencies, magnesium sulphate 1—2g IV delivered over one to two minutes is effective for treating and suppressing life-threatening ventricular tachyarrhythmias. Europace ; —5. Duirng J Ther. J Interv Card Electrophysiol.
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Pathology arises from the appearance of a foci of dkring in one of the conducting parts of the heart, which generates electrical impulses. One of the important factors that provoke a tachycardia during pregnancy is overweight. Consider the main causes of this pathology in pregnant women, methods Aborigines going nude diagnosis, treatment and Sinus tachycardia during pregnancy for recovery. These include: Nasal endoscopy. To think of it, an increased heart rate is actually perfectly natural during the term. Consider the main signs of tachycardia Pictures of hiv aids history pregnancy:. In fact, starting from the sixth month of pregnancy, the heart rhythm of a woman increases by BPM. I pfegnancy expected my recovery from my fifth baby to be easier, and I'm giving the credit to exercise. Herbal Remedies for Hot Flashes. Sinus tachycardia can be physiological due to physical or psycho-emotional loadnon-cardiac occurs due to fever, hypertension or hypotension, hypoglycemia, chronic infections, acute diseases, or drug overdose and cardiac tachycardia, which arises due to primary lesion of the heart. Sinus tachycardia is quite common during pregnancy, especially in anemic women. For preventive Sinus tachycardia during pregnancy, it is necessary to give up harmful habits, coffee, alcohol and nicotine. Good rest and the consumption of great amount of fluid for maintaining water balance in the body will help to cope with rapid heart rhythm. However, please do not hesitate to contact the doctor any time you want. The doctor collects information about the pregnant woman and determines the causes of the Sinus tachycardia during pregnancy.
Neither supraventricular nor ventricular tachyarrhythmias are uncommon during pregnancy.
- Give advice on women's health concerns.
- All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
- Pregnancy has its own set of symptoms.
- A heart rate above beats per minute BPM during pregnancy is termed as tachycardia.
- Fetal tachycardia in a pregnant woman is a pathological condition that is dangerous both for woman and fetus.
- Tachycardia in pregnancy is considered a normal condition, if it is caused by natural reasons, such as, physical fatigue or anxiety.
Inappropriate sinus tachycardia IST during pregnancy may be asymptomatic until maternal heart failure HF develops 1. There is no information on the safety of the use of ivabradine in pregnant patients.
A year-old patient, in the 17th week of her first pregnancy, was admitted to the local hospital with complaints of palpitations and shortness of breath, which progressed over a month. The patient had no prior history of any cardiac disease.
At the time of admission, the electrocardiogram ECG of the patient revealed that she had supraventricular tachycardia. When the patient did not respond to adenosine and electrical cardioversion, she was transferred to our hospital. She was continuously monitored, and intravenous esmolol infusion and oral metoprolol were started.
The patient developed severe MR. Furosemide was added to the treatment, but the patient did not experience clinical relief. Prior to ivabradine treatment, fetal echocardiography showed the fetal HR to be bpm Fig.
After the 1st day of ivabradine treatment, the fetal HR was bpm Fig. However, it did not decline further until delivery. Maternal tachycardia and fetal bradycardia were not detected during the monthly follow-ups. A healthy baby boy was delivered.
The electrocardiogram ECG taken at the time of admission showed that the patient had sinus tachycardia with a heart rate of bpm a. After ivabradine treatment, the ECG showed sinus rhythm with the heart rate reduced to 90 bpm c , and the ECG at discharge showed sinus rhythm within the normal range d.
Prior to starting treatment with ivabradine, fetal echocardio-graphy showed a heart rate of bpm a. On the 1st day of ivabradine treatment, the fetal ECG showed that the fetal heart rate was bpm b.
On the 1st week of ivabradine treatment, the fetal heart rate reduced to bpm c. After delivery, the mother continued her ivabradine treatment, and the ECG of the baby, who was fed only breast milk, showed sinus rhythm with a heart rate of bpm d. P-wave morphology is usually similar or identical to sinus rhythm. In general, IST is a diagnosis made by exclusion. The treatment for IST has been limited to calcium channel blockers, beta-blockers, antiarrhythmic drugs, and sometimes, radiofrequency ablation.
Although metoprolol, verapamil, and digoxin were used in maximum doses in our patient, the control of HR was not achieved and LVEF deteriorated each day, which led to the development of symptomatic HF.
The most popular choice for patients with drug-refractory IST is sinus node modification using radiofrequency ablation 2 , 3. However, our patient did not agree to undergo the procedure because of risks such as ionizing radiation, phrenic nerve injury, requirement for permanent pacing, and pericarditis. A specific HR reducing agent through the inhibition of pacemaker If current , ivabradine has been documented to be effective for treating angina pectoris and HF 4 , 5.
The benefit of ivabradine in patients with drug-refractory IST has been des-cribed 3 — 6. There is no information regarding the safety of ivabradine use during pregnancy. In the literature, there is only one study by Babic et al. The success of ivabradine treatment for IST-associated cardiomyopathy has been reported in 2 patients in the literature 8 , 9. In rats, ivabradine has been shown to pass to the breast milk, but its effect is unknown In our patient, the baby was only fed breast milk and neither bradycardia nor cardiac dysfunction was observed.
We have shown that ivabradine treatment improved tachycardia and HF in a pregnant patient with IST-induced cardiomyopathy. In addition, no maternal and fetal side effects were observed. However, further studies are still needed to evaluate the use of ivabradine treatment during pregnancy and breastfeeding.
National Center for Biotechnology Information , U. Journal List Anatol J Cardiol v. Anatol J Cardiol. Author information Copyright and License information Disclaimer. Address for Correspondence: Dr. This article has been cited by other articles in PMC. Introduction Inappropriate sinus tachycardia IST during pregnancy may be asymptomatic until maternal heart failure HF develops 1.
Case Report A year-old patient, in the 17th week of her first pregnancy, was admitted to the local hospital with complaints of palpitations and shortness of breath, which progressed over a month.
Open in a separate window. Figure 1. Figure 2. Conclusion We have shown that ivabradine treatment improved tachycardia and HF in a pregnant patient with IST-induced cardiomyopathy. References 1. Ablation of severe drug-resistant tachy-arrhythmia during pregnancy. J Cardiovasc Electrophysiol. Catheter ablation of inappropriate sinus tachycardia. J Interv Card Electrophysiol. Treatment for inappropriate sinus tachycardia. Am J Ther. New pharmacological agents for arrhythmias.
Circ Arrhythm Electrophysiol. Rakovec P. Treatment of inappropriate sinus tachycardia with iva-bradine. Wien Klin Wochensch. Successful primary percutaneous coronary intervention in the first trimester of pregnancy. Catheter Cardiovasc Interv. A case of cardiomyopathy induced by inappropriate sinus tachycardia and cured by ivabradine. Pacing Clin Electrophysiol. Reversal of tachycardiomyopathy due to left atrial tachycardia by ivabradine. Heart rate changes mediate the embryotoxic effect of antiarrhythmic drugs in the chick embryo.
Tachycardia in pregnancy is a pathological condition that causes anxiety in a woman, but the most dangerous - negatively affects the full development of the fetus. Taking adequate rest, drinking plenty of water and other healthy liquids to keep the body cool and well hydrated, are some of the simple remedies that can help the body in handling the changes in the heartbeats. In severe situations, the pregnant mother may faint or experience numbness. With a mild form, a pregnant woman needs to drink more water and use special relaxation techniques to normalize the rhythm of the heart. Sore Breasts After Period. Getting sick with a sinus infection while having these pregnancy symptoms can take a toll on the body. Let's consider the basic diagnostic procedures at the increased palpitation at the pregnant woman:.
Sinus tachycardia during pregnancy. Related Articles
Pregnancy also refers to the factors that provoke this pathology. This type of tachycardia is pathological and physiological. The first arises from the pathologies of the sinus node, and the second is an adaptive response. Symptomatology depends on the presence of concomitant diseases of the cardiovascular system. If a woman has left ventricular dysfunction or a heart defect, then during pregnancy this will cause supraventricular tachyarrhythmia, chest pain, shortness of breath and heart palpitations.
More pronounced heart palpitations may be in the last trimester, since during this period the fetus is practically formed and the processes of vital activity are quite intense. A woman may experience nausea, vomiting, chest pain and other symptoms. The danger is an increase in the regular heart rate, which is accompanied by prolonged bouts. If the tachycardia is not caused by organic pathologies of the heart, then it can be eliminated with sedatives.
If therapy is not performed on time, the pregnant woman may develop sleep disturbance, anxiety, and the protective properties of the immune system decrease.
Rapid palpitation can go into persistent arrhythmia, lead to pressure drops. Tachycardia in the early stages of pregnancy occurs very rarely and, as a rule, appears due to various provoking factors. Physical stress, excitement, bad habits, hormonal changes - refer to the factors that cause heart palpitations.
If the rapid tachycardia appeared from the first weeks of pregnancy, and has a permanent character, the pathology can be caused by chronic diseases or lesions of the cardiovascular system.
Tachycardia in the first trimester should cause concern, as it may indicate pathological processes in the body. Consider cases of rapid heartbeat that require medical attention:. In order to eliminate an easy attack of tachycardia in the early stages of pregnancy, you need to relax as much as possible. A woman is recommended to take a comfortable position, lie down or sit down, close her eyes for a couple of minutes, slowly inhale and exhale.
Very often heart palpitations in the early stages of pregnancy arise due to hormonal changes in the mother's body. In this case, to treat seizures, women are prescribed calming preparations on a plant basis, which allows them to remain calm and do not feel discomfort due to natural processes in the body.
Tachycardia in late pregnancy appears in every woman. The main cause of rapid heart rate is the growth and increase in the size of the fetus. In the last trimester, the bottom of the growing uterus can shift the heart, which leads to disturbances in its rhythm and an increase in heart rate. In this case, heart palpitations are quite a natural process, which should not be feared. Dangerous is the heart palpitations, in which the heart rate exceeds beats per minute in a calm state.
A woman feels pain in the heart and discomfort. For treatment use relaxing therapy and safe preparations with herbal ingredients. It is a pathological condition in which cardiac contractions are at the level of beats per minute.
The duration of an attack can be from a few seconds to several hours, or even days. Pathology arises from the appearance of a foci of excitation in one of the conducting parts of the heart, which generates electrical impulses. The focus can appear in the ventricles or cells of the conducting system of the atria.
On this basis, tachycardia can be ventricular or atrial. Paroxysmal tachycardia depends on the source of the lesion. Paroxysm begins unexpectedly and also unexpectedly passes. The main symptoms of paroxysmal tachycardia during pregnancy:. When the symptoms described above need to seek medical help or call an ambulance. Ventricular paroxysmal tachycardia arises from pathologies of the cardiovascular system, for example, myocarditis, myocardial infarction or intoxication caused by medical drugs.
This condition is dangerous both for a woman and her future child. With atrial paroxysmal tachycardia, the rapid heart rate is not the only symptom.
The cause of the pathology is oxygen starvation of the heart muscle, endocrine disruption and other disorders. The woman has pain in the chest, in some cases, there is a feeling of lack of air, chills, profuse urination, a sense of lack of air.
Treatment requires qualified medical care. As a rule, during the gestation period, the therapy is carried out with the safest possible medications, but after the delivery, surgical intervention is possible. Attacks of tachycardia during pregnancy can occur both in the first months of the gestational period, and in the last trimester.
Attacks are accompanied by characteristic symptoms: paroxysmal frequency of heart rhythm, chest pain, general weakness, dizziness, lack of air.
Attacks appear due to stress, fatigue, lack of sleep. Reducing blood sugar, hypertension shchitovidki, high blood pressure and myocarditis also relate to the causes of rapid heartbeat. There are a number of reasons that trigger the appearance of an attack of tachycardia, and the symptomatology allows you to identify and eliminate the rapid heart rate in time.
The attack is characterized by a pulse rate of more than beats per minute. To eliminate pathology, it is necessary to use special methods:. Strong tachycardia during pregnancy is a sign of serious pathological processes in the body of a woman.
Strong attacks of rapid heartbeats cause dizziness, nausea, weakness, fainting and other, unpleasant and even painful symptoms. This pathology requires medical attention, since without proper treatment can lead to serious consequences. An increased heart rate increases the risk of complications during the labor process. Due to a constant increase in heart rate, premature birth may develop. If severe attacks accompany a woman from the first days of pregnancy, it can lead to miscarriage or development of pathologies in the unborn child.
Whether tachycardia is dangerous during pregnancy is a question that interests many expectant mothers who have experienced increased heart rate at the most important moment for every woman. An increase in heart rate significantly worsens the quality of life, causes unfavorable symptoms, and without necessary treatment does not pass without a trace and after pregnancy.
Pathology can arise because of worsening chronic diseases. Especially dangerous is tachycardia associated with diseases of the cardiovascular system, since this can be a threat to the life not only of the child, but also of the woman.
An increased heart rate increases the risk of developing complications during the birth process and gestation. Slight palpitations are not dangerous. But if the attacks are very often and have a long-lasting character, you must always consult a cardiologist and obstetrician-gynecologist.
With an increased heart rate with a heart rate above beats per minute, a woman has nausea, dizziness, general ailments, fainting and severe chest pains. Diagnosis of tachycardia during pregnancy is a mandatory procedure, with which doctors can determine the type of pathology and choose the necessary treatment.
Let's consider the basic diagnostic procedures at the increased palpitation at the pregnant woman:. Based on the diagnostic results, the doctor makes the most effective and safe treatment that will help to eliminate the increased heart rate, but will not affect the course of pregnancy and fetal development. When choosing a therapy, the doctor takes into account the causes of rapid heartbeat, the age of the woman, the duration of pregnancy, the presence of concomitant diseases.
In most cases, rapid heartbeat does not require special treatment, it is sufficient to eliminate the causes that caused it. What to do with tachycardia during pregnancy is a topical issue for many expectant mothers who have experienced discomfort from palpitations. As a rule, it appears in the case when a woman begins to worry. But enough to relax and the heart rate comes back to normal. In this case, an increase in heart rate does not pose a threat.
This also applies to the rapid heartbeat caused by increased physical activity. The danger is represented by attacks of tachycardia, which do not stop for a long time.
In this case, a woman should seek medical help to diagnose the condition. The doctor collects information about the pregnant woman and determines the causes of the pathology. One of the important factors that provoke a tachycardia during pregnancy is overweight. This is due to the fact that during pregnancy a woman very quickly gaining weight, which is one of the causes of tachycardia. Rapid palpitation can be caused by the harmful habits of a future mother.
A woman should give up smoking, caffeine, alcohol and drugs. If the pathology is caused by diseases of the lungs or the cardiovascular system, then doctors prescribe drug therapy. The woman is prescribed antiarrhythmic drugs, beta-blockers and calcium channel blockers. Treatment depends on many of the attendant factors, so taking any medication is necessary only with the permission of the doctor. It is strictly prohibited to engage in self-medication, as this will lead to serious health problems and jeopardize the pregnancy and health of the baby's future.
Therapy depends on the causes of rapid heart rate and the type of tachycardia. In most cases, unpleasant symptoms pass independently. For this, a woman needs to rest, sleep, stop being nervous. But sometimes it is necessary and medicamental treatment. Anxiety should cause a rapid heartbeat, which arose for no apparent reason. The main treatment is aimed at eliminating the cause of pathology, improving the woman's well-being and preventing relapses of tachycardia.
If the cause can not be established, different methods are used for the treatment, which effectively restore the normal heart rhythm. Before taking any medications during pregnancy, you should consult your doctor and carefully read the instructions to the drug. Tablets from tachycardia during pregnancy help restore normal heart rhythm, prevent attacks and allow you to keep the heart rate under control.
The choice of tablets depends on the type of tachycardia, the presence of concomitant diseases in pregnant women, the duration of pregnancy and its general course, the side effects of the chosen drug and the patient's reaction to the therapy. Medicinal products are made on the basis of herbs and plants. Preparations can have a synthetic origin, for example: Diazepam, Fenobatbital. Tablets are prescribed for the treatment of rapid heart rate, vegetative-vascular dystonia.
Drugs reduce the frequency of tachycardia attacks and allow the normalization of the nervous system. A wide group of drugs that can only be used as directed by a doctor.
Self-medication is dangerous, since any medications used in pregnancy can lead to uncontrolled side effects. The most common drugs from this group: Adenosine, Verapamil, Propranolol, Flekanil.
Tablets normalize the heart rate. Since the treatment of tachycardia during pregnancy depends on its kind, we will consider therapy of different types of rapid heartbeat:. With ventricular tachycardia, urgent treatment is performed. In case of a sudden attack, a woman should go to fresh air, take a tablet of Validol or Valocordin these drugs are considered safe to eliminate seizures.
After the woman is sent to inpatient treatment, the doctors administer Quinidine, Novokainomid and other drugs from this group. Anti-arrhythmic medicines are prescribed under medical supervision. Limit contact with sick people.
Consider wearing a facial mask to protect yourself from germs. If you have allergies, ask your doctor about pregnancy-safe antihistamines to manage your symptoms prescription or OTC. Also avoid situations that can trigger an allergy flare-up. Avoid establishments with heavy scents or cigarette smoke.
Stop using fragrances and cleaning products with strong odors. Dry air prevents the sinuses from draining, so using a humidifier to increase the moisture level in your home can also reduce your risk of a sinus infection. If you're experiencing changes to your dreams since your pregnancy began, you aren't alone. Learn more about what the causes may be, what types of…. Is that nausea you're feeling actually morning sickness?
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What causes a sinus infection? Treating a sinus infection while pregnant. Other medications might be safe to take during pregnancy. Home remedies for a sinus infection during pregnancy. Run a humidifier at night to keep your nasal passage clear and thin mucus. Sleep with more than one pillow to elevate your head.
This stops mucus from accumulating in your sinuses at night. Use steam to help loosen the mucus. Gargle with warm salt water to soothe a sore throat, or suck on throat lozenges. Slow down and relax. Rest can strengthen your immune system and help you fight the infection.
When to see your doctor. Tests for a sinus infection during pregnancy. If you seek medical attention, your doctor may conduct a variety of tests.
These include: Nasal endoscopy. Your doctor inserts a thin, flexible tube into your nose to examine your sinuses.
Tachyarrhythmias During Pregnancy
Neither supraventricular nor ventricular tachyarrhythmias are uncommon during pregnancy. In addition, in every pregnant woman with an arrhythmia, foetal cardiac assessment is necessary because foetal tachyarrhythmias can occur alone or combined with tachyarrhythmias of the mother.
Correct therapy based on an understanding of the mechanism that caused the arrhythmia may not only be life-saving for the mother but also may play an important role for the foetus. Supraventricular or ventricular tachyarrhythmias can become more frequent or may develop for the first time during pregnancy. Of patients with an accessory-pathway-mediated tachycardia, seven had the first onset of tachycardia during pregnancy.
Of the patients with atrioventricular AV nodal re-entrant tachycardia, one had the first onset of tachycardia during pregnancy.
Ventricular tachycardia VT is rarely observed during pregnancy: Nakagawa et al. The onset of the first episode was distributed equally over the three trimesters. The authors concluded that various haemodynamic and neurohumoral changes associated with pregnancy play an important role in ventricular arrhythmogenesis.
Shotan et al 14 assessed the relationship between symptoms and cardiac arrhythmias in consecutive pregnant patients without evidence of heart disease referred for evaluation of palpitations, dizziness and syncope group G I. These patients were compared with 52 consecutive pregnant patients referred for evaluation of symptomatic functional precordial murmur group G II. VT or ventricular fibrillation VF was not recorded in any of the patients.
Before initiating therapy, it is important to correctly diagnose the type and mechanism of the underlying arrhythmia so that the proper therapeutic modalities can be implemented. Clues for correct diagnosis and treatment come from findings during physical examination and correct analysis of the electrocardiogram ECG. In utero , all types of arrhythmia can occur. They are frequently intermittent and may disappear until delivery or the neonatal period.
It has been reported that AV nodal re-entrant tachycardia, ectopic atrial tachycardia or atrial flutter AFlut are serious and threatening rhythm disorders in the human foetus. In some cases, the foetal congenital AV block is caused by QT prolongation or immune-mediated diseases.
The description of intrauterine AFlut by Carr and McLure in is probably the first published report. Blumenthal et al. Currently, foetal echocardiography is the best method and remains the cornerstone for in utero diagnosis of arrhythmias.
Conventional foetal echocardiography views of the heart were obtained to exclude structural heart malformation. In many patients with narrow-QRS-complex tachycardia, the tachycardia rate is very high —bpm ; therefore, after onset of the tachycardia the patient will arrive very soon thereafter in an intensive care unit for diagnosis and treatment.
The definitive diagnosis of narrow-QRS-complex tachycardia can be made in most patients based on the lead ECG and clinical criteria. Acute treatment should be initiated based on the underlying mechanism. Specific antiarrhythmic drugs should be avoided whenever possible in these conditions, because all commonly used antiarrhythmic drugs cross the placenta and may cause serious side effects to the foetus. The advantage of adenosine 9—18mg intravenous IV as bolus relative to intravenous calcium antagonists or beta-blockers relates to its rapidity of onset and short half-life.
Clinical studies of verapamil in pregnant woman have not demonstrated adverse effects on either patient or foetus. However, IV administration of verapamil carries a risk of precipitating maternal hypotension and secondary hypoperfusion.
In addition, verapamil is capable of causing foetal bradycardia, high-degree AV block and hypotension. Pregnancy is also related to an increased frequency of arrhythmias in previously asymptomatic patients with Wolff-Parkinson- White syndrome.
Therefore, ajmalin should be avoided during the first trimester and used only when other therapeutic alternatives are not present or even unsuccessful. Any arrhythmia can occur in the pregnant woman and the frequency and symptomatic severity of arrhythmias may be increased during pregnancy.
Although AF and AFlut are very frequent arrhythmias in adult non-pregnant patients, AF and AFlut are unusual in the absence of structural heart disease. However, IV administration of verapamil carries a risk of precipitating maternal hypotension and secondary hypoperfusion, causing foetal bradycardia, high-degree AV block and hypotension.
APBs in pregnant woman with structurally normal hearts are benign. Exacerbating factors, such as chemical stimulants, should be identified and eliminated. Drug therapy is not needed in the vast majority of pregnant women.
The few randomised studies of their use in pregnancy have yielded conflicting results regarding their effectiveness and safety. Beta-blocking agents readily cross the placenta and could, in large doses, cause a relative foetal bradycardia.
One of the most important problems in intensive care, emergency medicine and cardiac rhythmology are pregnant patients with recurrent VT, ventricular flutter VFlut or VF. Management of cardiac arrest due to life-threatening ventricular tachyarrhythmias is essential to prevent sudden cardiac death in the mother and the foetus. However, treatment of the underlying arrhythmia requires a correct diagnosis. This is possible in the majority of patients using a lead surface ECG.
Because a drug given for the treatment of SVT may be deleterious to a patient with VT, the differential diagnosis of a broad QRS tachycardia is critical. To make the right diagnosis, a lead ECG is ideal. There are several possible mechanisms of wide-QRS-complex tachycardia.
In contrast to pregnant patients with normal left ventricular function, there is a poor prognosis when VT is associated with structural heart disease. If at any time VT becomes unstable or there is evidence of foetal compromise, DC countershock 50—J should be delivered immediately see Figure 1.
If a DC shock of 50—J is unsuccessful, higher energy is mandatory —J ; this carries no risk for mother or child. Acute therapy should start with IV procainamide or with ajmaline 50—mg IV over five minutes. Procainamide appears to be equally safe, is well tolerated and has no associated teratotoxicity, whereas the potential risk of ajmalin during pregnancy is unclear and its administration should be limited to emergencies.
Another potential antiarrhythmic drug is lidocaine, which is not known to be teratogenic. Although several studies have shown some adverse effects increase in myometrial tone, decrease of placental blood flow, foetal bradycardia , its use during the early stages of pregnancy is not associated with a significant increase in the incidence of foetal defects.
Amiodarone is well known for its many and serious side effects for both the mother and the foetus, including hypothyroidism, growth retardation and premature delivery. It has been known for a long time that in emergencies, magnesium sulphate 1—2g IV delivered over one to two minutes is effective for treating and suppressing life-threatening ventricular tachyarrhythmias. Although this drug is associated with few side effects, maternal hypothermia and foetal bradyarrhythmias have been observed.
Life-threatening VF or VFlut can occur at any stage of pregnancy and is associated with a high risk of sudden cardiac death. Prompt cardiopulmonary resuscitation and early defibrillation by either DC countershock or an automated external defibrillator significantly improve the likelihood of successful resuscitation from VF.
There are few reports on ICD therapy during pregnancy, and these studies clearly show that ICD implantation did not negatively influence pregnancy, delivery or foetal health. Ventricular premature beats VPBs in pregnant woman with structurally normal hearts are benign and therapy is usually not necessary. Management of foetal arrhythmias is very difficult and requires co-operation between different consultants obstetrics, cardiology, neonatology.
The problem of foetal tachyarrhythmias is the risk of hydrops fetalis and subsequent death. An analysis of 11 studies reported from to showed a foetal SVT as the underlying arrhythmia in Intrauterine death was 8. The treatment of foetal arrhythmias is possible by either treating the mother or treating the foetus directly. Antiarrhythmic agents that have been used to treat foetal arrhythmias include digoxin, beta-blocking agents, verapamil, procainamide and quinidine.
In addition, in cases of foetal ventricular tachyarrhythmias, class I and class III antiarrhythmic agents have been advocated. The woman was treated with flecainide and digoxin and tachycardia converted to sinus rhythm.
A few days later, no signs of foetal heart failure were present. In another publication, Khosithseth et al. If maternal therapy fails to suppress or sufficiently decrease the rate of foetal tachyarrhythmias, direct drug administration to the foetus is mandatory. In addition, umbilical drug administration allows not only direct treatment but also drug monitoring. Hansmann et al. When tachyarrhythmias were refractory to transplacental treatment, foetal therapy was performed with direct umbilical drug administration.
During the nine years of the study, different drug regimes had been used. Therefore, direct foetal therapy is highly effective in SVT and AFlut and will lead to foetal survival. Amiodarone seems to be the drug of choice for direct therapy; however, there are also other effective drugs digoxin, beta-blocking agents, flecainide, adenosin.
Correct treatment of arrhythmias in the intensive care patient should be based on understanding the causal mechanism. In general, acute therapy of arrhythmias during pregnancy is similar to that in the non-pregnant patient. However, special consideration should be given to potential teratogenic and haemodynamic adverse effects on the foetus. With this in mind, a successful pregnancy, for both mother and foetus, can usually be the result.
Skip to main content. Radcliffe Cardiology. Search form Search this site. Login Register. Hans-Joachim Trappe. Login or register to view PDF. Order reprints. Maternal Arrhythmias During Pregnancy Incidence and First Manifestation Supraventricular or ventricular tachyarrhythmias can become more frequent or may develop for the first time during pregnancy. Maternal Therapy The treatment of foetal arrhythmias is possible by either treating the mother or treating the foetus directly.
In: Long WA ed. A safe combination? A case report of treatment with propranolol hydrochloride, Fetal Diagn Ther, ; —6. Crossref PubMed. View All Articles. View ejournal.