Jermolajevaitė Justina1, Baliuliene Vilda2, Vitartaitė Migle1
1Lithuanian University of Health Sciences, Medical Academy, Faculty of Medicine
2Lithuanian University of Health Sciences Kaunas Clinics, Department
of Anesthesiology, Kaunas, Lithuania
Abstract
Background: Cardiovascular disease is diagnosed for 1 – 4% of pregnant women [1] and it is the most common cause of maternal death in developed countries [2].
Aim: To present the case of heart failure in pregnancy and to discuss major pre-partum, intra-partum and post-partum points of care.
Case report: A 30 years old woman, gravida II (39 weeks of gestation) was admitted to the university teaching hospital with acute heart failure (HF) (NYHA cl.III) and bilateral hydrothorax. The irregular uterus contractions were present. At the age of 20 she was diagnosed with Hodgkin’s lymphoma, treatment involved chemotherapy and radiotherapy and leaded to remission afterwards. At the age of 27 she had uncomplicated pregnancy and vaginal delivery. Any preexisting cardiovascular disease was not known.
ECG: sinus tachycardia, heart rate (HR) 124 beats/min, QTc 461ms. Echocardiography: Left ventricle systolic dysfunction EF (ejection fraction) 50%, III֯ MR (mitral regurgitation), II֯ TR (tricuspid regurgitation). Upper abdominal ultrasound: up to 10 cm fluid in pleural cavity bilaterally. NT-proBNP was 1719 ng/l. Multidisciplinary team (obstetrician – gynecologist, anesthesiologist – reanimatologist, cardiologist, cardio surgeon) decided to reduce fluid volume in the pleural cavity by punction and drainage and induce natural delivery.
Delivery pain management with intramuscular opioids was adequate. Healthy boy was born, Apgar score after 1 and 5 min was 9 – 10. HF persisted after delivery, so patient was moved to cardiology department. Nevertheless, conservative treatment was not effective and mitral and tricuspidal valve plastics was performed 6 months after delivery.
Conclusion: Pregnant women with HF have a high risk of mortality. Physiological changes of cardiovascular system during pregnancy deteriorate preexisting condition dramatically. In this clinical case the probable cardiac damage and congestive heart failure could have been determined by radio-chemotherapy for Hodgkin’s lymphoma.
Keywords: heart failure in pregnancy, Hodgkin’s lymphoma, management of heart failure.