Abstract Proceedings EROC 2011 - New York Osteopathic Medical ...

EROC 2011 Abstract Proceedings – March 4, 2011
Dept. of Emergency Medicine, Newark Beth Israel Medical Center, Newark, NJ
Title: Supraventricular Tachycardia in Pregnancy
Author: Eli Cohen, DO
Newark Beth Israel Medical Center, Department of Emergency Medicine, Newark, NJ 07112
Introduction: Arrhythmias are the most common cardiac complication occurring during
pregnancy in women without structural heart disease. Paroxysmal supraventricular tachycardia
(SVT) is the most common arrhythmia in pregnancy with conservative incidence of 4%. This
case is of interest because pregnancy has been identified as a risk factor for paroxysmal SVT.
When SVT fails to be self limited or hemodynamic compromise arises, immediate intervention is
necessary to prevent harm to mother and fetus.
Case Description: A 41-year-old African American female presented to the emergency
department with palpitations for 2 days. Associated symptoms included fatigue, urinary
frequency and two weeks of left flank pain. Otherwise, patient denied fever, nausea, vomiting,
chest pain or shortness of breath.
Physical examination was remarkable for pulse 208 bpm, blood pressure 128/77, room air pulse
oximetry 98%. Heart sounds were significant for a regular tachycardia. Patient’s abdominal and
back exam was significant for left CVA tenderness. Otherwise, no jugular venous distention,
palpable thyromegaly, lower extremity edema or calf tenderness was noted.
Initial electrocardiogram revealed supraventricular tachycardia at 206 bpm with left ventricular
hypertrophy. Patient was given adenosine 6mg IV rapid push with immediate resolution of
tachyarrythmia. Repeat electrocardiogram revealed normal sinus rhythm at 98 bpm, normal axis,
with left ventricular hypertrophy. Laboratory analysis revealed mild white blood cell count
elevation with normal differential and a positive urine pregnancy test. Bedside transabdominal
ultrasound revealed an intrauterine fetal yolk sac with absence of free pelvic fluid. Patient was
monitored for several hours following cardioversion and discharged home.
Discussion: This case illustrates the importance of understanding cardiac arrhythmias during
pregnancy. Prompt intervention ensures positive outcome for mother and fetus. When
hemodynamically stable, acute episodes of SVT in pregnancy may be terminated by blocking
AV nodal conduction. Additional emphasis on the frequency and management of cardiac
arrhythmias during pregnancy is needed.
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