Book of Medical Disorders in Pregnancy - Tintash

dominant). Jervell + Lange Nielson
syndrome (autosomal recessive) associated
with sensorineural deafness,
normal ST segment, no elevation or
depression and causes of elevation
include acute MI (e.g. anterior, inferior),
left bundle branch block, normal variants
(e.g. athletic heart, Ed Eiken pattern,
high-take off), and acute pericarditis.
Causes of depression include myocardial
ischemia, digoxin effect, ventricular
hypertrophy, acute posterior MI, pulmonary
embolus, left bundle branch
block, normal T wave, causes of tall T
waves include hyperkaliemia, hyperacute
myocardial infarction and left
bundle branch block. Causes of small,
flattened or inverted T waves are
numerous and include ischemia, age,
race, hyperventilation, anxiety, drinking
iced water, LVH, drugs (e.g. digoxin),
pericarditis, PE, intraventricular conduction
delay (e.g. RBBB)and electrolyte
disturbance and normal U wave.
Echocardiography:
This is quite useful in confirming the
presence of the mitral valve prolapse
syndrome. It also helps in assessing the
degree of mitral stenosis and in excluding
the presence of hypertrophic
cardiomyopathy. Both aortic valve disease
and a reliable measurement of left
atrial size can be assessed by this
method block and a slow ventricular
rate, a transvenous pacemaker can be
inserted with no great risk. The student
must note
Cardiac complications and
management in pregnancy:
Dysrhythmias: Paroxysmal atrial
tachycardia is a common feature during
pregnancy. Premature beats, atrial or
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ventricular can also occur without heart
disease. When heart disease is present,
any attack of atrial fibrillation, with
rapid ventricular rate can pose a serious
problem. Direct current countershock
conversion has been used in pregnancy
with no evidence of any serious effect on
the fetus. In patients with complete heart
that if a pregnant patient with tight
mitral stenosis goes from normal sinus
rhythm into atrial fibrillation, the rapid
control the ventricular rate. This will
allowance adequate period of ventricular
filling and thus prevent the rapid
development of pulmonary edema.
Ventricular rate may be lethal. Proper
digitalization can reduce the chance of
developing atrial fibrillation and also
Drugs - Both quinidine or procainamide
can be used during pregnancy to control
dysrhythmias. However, propranolol
should be avoided. When administered
during pregnancy it can produce postnatal
bradycardia, hypoglycemia and
impair responsiveness of the fetus to
anoxic stress. Propranolol administered
to the mother crosses the placenta. This
drug is strongly bound to albumin and
tissues, and may continue to be released
from such binding sites over a 2 to 3 day
period. Severe hypoglycemia in the neonate
where mothers had been given propranolol
has been reported, with blood
sugar levels of 11 to 30 MG dl and
persisting for about 8 to 24 hours after
delivery. Treatment of hypoglycemia
consists of administering a 10 per cent
dextrose solution to the baby. Beta
blockade impairs the ability of the fetus
to develop a rebound tachycardia in response
to transient anoxia. This is
possibly the explanation for impaired
responsiveness to anoxic stress. The
depressed state of the fetus at birth, with
delay in onset of sustained breathing,