Cardiac disease in pregnancy and arrhythmias: Difference between revisions

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__NOTOC__
{{Cardiac disease in pregnancy}}
{{Cardiac disease in pregnancy}}
{{CMG}}; {{AOEIC}} {{CZ}}   
{{CMG}}; {{AOEIC}} {{CZ}}   
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==Overview==
==Overview==
Although underlying reasons remain unclear, if a woman has a prior history of [[arrhythmias]], the risk of recurrent arrhythmias may increase during pregnancy.<ref> Tawam M, Levine J, Mendelson M, Goldberger J, Dyer A, Kadish A. Effect of pregnancy on paroxysmal supraventricular tachycardia. Am J Cardiol 1993; 72: 838-40.</ref> <ref>Brodsky M, Doria R, Allen B, Sato D, Thomas G, Sada M. New-onset ventricular tachycardia during pregnancy. Am Heart J 1992; 123: 933-41.</ref> <ref name="Chow">Chow T, Galvin J, McGovern B. Antiarrhythmic drug therapy in pregnancy and lactation. Am J Cardiol 1998; 82 (4A): 58I - 62I. </ref>  Unfortunately drugs that are effective in the management of arrhythmias such as [[amiodarone]] can present a hazard to the fetus during pregnancy.
Although underlying reasons remain unclear, if a woman has a prior history of [[arrhythmias]], the risk of recurrent arrhythmias may increase during pregnancy.<ref> Tawam M, Levine J, Mendelson M, Goldberger J, Dyer A, Kadish A. Effect of pregnancy on paroxysmal supraventricular tachycardia. Am J Cardiol 1993; 72: 838-40.</ref> <ref>Brodsky M, Doria R, Allen B, Sato D, Thomas G, Sada M. New-onset ventricular tachycardia during pregnancy. Am Heart J 1992; 123: 933-41.</ref> <ref name="Chow">Chow T, Galvin J, McGovern B. Antiarrhythmic drug therapy in pregnancy and lactation. Am J Cardiol 1998; 82 (4A): 58I - 62I. </ref>  Unfortunately drugs that are effective in the management of arrhythmias such as [[amiodarone]] can present a hazard to the fetus during pregnancy.
 
==Arrythmias==
==Supraventricular Tachycardias During Pregnancy==
===Supraventricular Tachycardia During Pregnancy===
*If there is hemodynamic compromise, the patient can be treated with DC [[cardioversion]].
*If there is hemodynamic compromise, the patient can be treated with DC [[cardioversion]].
*A rapid narrow complex rhythm suggestive of [[AV nodal re-entry tachycardia]] ([[AVNRT]]) can be treated emergently with IV [[adenosine]] which has a very short half life.
*A rapid narrow complex rhythm suggestive of [[AV nodal re-entry tachycardia]] ([[AVNRT]]) can be treated emergently with IV [[adenosine]] which has a very short half life.
*[[Lopressor]] is a mainstay of prevention of [[SVT]] in the setting of pregnancy. [[Atenolol]] and [[propranolol]] should be avoided given the risk of [[intrauterine growth retardation]].  [[Calcium channel blockade]] would be second line therapy.  [[Sotalol]] and [[flecainide]] can be used in refractory cases.  Ablation can be performed in refractory cases. Given the risk of fetal hypo/hyperthyroidism with amiodarone, this agent is not recommended.
*[[Lopressor]] is a mainstay of prevention of [[SVT]] in the setting of pregnancy. [[Atenolol]] and [[propranolol]] should be avoided given the risk of [[intrauterine growth retardation]].  [[Calcium channel blockade]] would be second line therapy.  [[Sotalol]] and [[flecainide]] can be used in refractory cases.  Ablation can be performed in refractory cases. Given the risk of fetal hypo/hyperthyroidism with amiodarone, this agent is not recommended.


==Ventricular Tachycardia During Pregnancy==
===Ventricular Tachycardia During Pregnancy===
===Acute VT===
====Acute VT====
*If there is hemodynamic compromise, DC [[cardioversion]] is recommended.
*If there is hemodynamic compromise, DC [[cardioversion]] is recommended.
*If the patient is hemodynamically stable with symptoms, then [[lidocaine]], [[procainamide]] or as a last resort, [[amiodarone]] are recommended.
*If the patient is hemodynamically stable with symptoms, then [[lidocaine]], [[procainamide]] or as a last resort, [[amiodarone]] are recommended.
===Recurrent VT===
====Recurrent VT====
*Ascertaining and directing the appropriate therapy to the underlying cause of the VT is critical such as [[right ventricular outflow tract tachycardia]], [[Long QT Syndrome]] (treat with [[beta-blockers]]).
*Ascertaining and directing the appropriate therapy to the underlying cause of the VT is critical such as [[right ventricular outflow tract tachycardia]], [[Long QT Syndrome]] (treat with [[beta-blockers]]).
*The following drugs are pregnancy category C drugs, and can be administered if the benefits outweigh the risks:
*The following drugs are pregnancy category C drugs, and can be administered if the benefits outweigh the risks:
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*[[Amiodarone]] is a [[pregnancy category]] D drug.  Amiodarone has been associated with fetal [[hypothyroidism]] and [[hyperthyroidism]], fetal bradycardia, [[intrauterine growth retardation]].  The expert consensus is that amiodarone use should be restricted to the management of refractory maternal or fetal tachyarrhythmias.  Given the long half life of amiodarone, if a woman intends to become pregnant, the drug should be discontinued several months before conception.  [[Thyroid function tests]] in the neonate are recommended if the mother is administered [[amiodarone]].
*[[Amiodarone]] is a [[pregnancy category]] D drug.  Amiodarone has been associated with fetal [[hypothyroidism]] and [[hyperthyroidism]], fetal bradycardia, [[intrauterine growth retardation]].  The expert consensus is that amiodarone use should be restricted to the management of refractory maternal or fetal tachyarrhythmias.  Given the long half life of amiodarone, if a woman intends to become pregnant, the drug should be discontinued several months before conception.  [[Thyroid function tests]] in the neonate are recommended if the mother is administered [[amiodarone]].


==Anti-arrhythmic Drugs to Avoid During the Pregnancy==
===Anti-arrhythmic Drugs to Avoid During the Pregnancy===


* [[Amiodarone]]<ref name="Onuigbo"> Onuigbo M, Alikhan M. Over-the-counter sympathomimetics: a risk factor for cardiac arrhythmias in pregnancy. South Med J 1998; 91: 1153-5.</ref>:
* [[Amiodarone]]<ref name="Onuigbo"> Onuigbo M, Alikhan M. Over-the-counter sympathomimetics: a risk factor for cardiac arrhythmias in pregnancy. South Med J 1998; 91: 1153-5.</ref>:
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:* [[Hypoglycemia]] in the newborn
:* [[Hypoglycemia]] in the newborn


==Anti-arrhythmic Drugs to Avoid During Lactation==
===Anti-arrhythmic Drugs to Avoid During Lactation===


* [[Amiodarone]]<ref name="Onuigbo"> Onuigbo M, Alikhan M. Over-the-counter sympathomimetics: a risk factor for cardiac arrhythmias in pregnancy. South Med J 1998; 91: 1153-5.</ref>:
* [[Amiodarone]]<ref name="Onuigbo"> Onuigbo M, Alikhan M. Over-the-counter sympathomimetics: a risk factor for cardiac arrhythmias in pregnancy. South Med J 1998; 91: 1153-5.</ref>:
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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 20:47, 29 July 2020

Cardiac disease in pregnancy Microchapters

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III. Cardiomyopathy:
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IV. Cardiac diseases that may develop During Pregnancy:
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Although underlying reasons remain unclear, if a woman has a prior history of arrhythmias, the risk of recurrent arrhythmias may increase during pregnancy.[1] [2] [3] Unfortunately drugs that are effective in the management of arrhythmias such as amiodarone can present a hazard to the fetus during pregnancy.

Arrythmias

Supraventricular Tachycardia During Pregnancy

Ventricular Tachycardia During Pregnancy

Acute VT

Recurrent VT

Anti-arrhythmic Drugs to Avoid During the Pregnancy

Anti-arrhythmic Drugs to Avoid During Lactation

  • Secreted in breast milk
  • It becomes concentrated in breast milk. Infants receive much larger doses.
  • Neonatal bradycardia
  • Neonatal hypoglycemia

Related Chapters

References

  1. Tawam M, Levine J, Mendelson M, Goldberger J, Dyer A, Kadish A. Effect of pregnancy on paroxysmal supraventricular tachycardia. Am J Cardiol 1993; 72: 838-40.
  2. Brodsky M, Doria R, Allen B, Sato D, Thomas G, Sada M. New-onset ventricular tachycardia during pregnancy. Am Heart J 1992; 123: 933-41.
  3. Chow T, Galvin J, McGovern B. Antiarrhythmic drug therapy in pregnancy and lactation. Am J Cardiol 1998; 82 (4A): 58I - 62I.
  4. 4.0 4.1 4.2 Onuigbo M, Alikhan M. Over-the-counter sympathomimetics: a risk factor for cardiac arrhythmias in pregnancy. South Med J 1998; 91: 1153-5.
  5. Eliahou HE, Silverberg DS, Reisin E, Romem I, Mashiach S, Serr DM. Propranolol for the treatment of hypertension in pregnancy. Br J Obstet Gynaecol 1978;85:431-6.
  6. Lydakis C, Lip GY, Beevers M, Beevers DG. Atenolol and fetal growth in pregnancies complicated by hypertension. Am J Hypertens 1999; 12:541-7.


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