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Therapeutic challenges and management of heart failure during pregnancy (part I).

Abstract

Therapeutic management in pregnant patients with heart failure still remains a challenge, even though in most pregnant women with cardiac diseases an outcome is good. A 32-year-old woman, 17 weeks pregnant, was admitted to hospital with heart failure (HF) NYHA class III/IV. Echocardiography revealed enlarged LV, LVEF 13%, significant mitral insufficiency and pulmonary hypertension. The patient wished to continue the pregnancy. In a life-threatening condition, metoprolol, enalapril, spironolactone (for 5 days), furosemide, and digitalis were administered. Enalapril was continued for 42 days. Then the patient was switched to a dihydralazine and isosorbide mononitrate regimen. The fetus was controlled ultrasonographically. In the 19th week of pregnancy, the patient's condition improved (NYHA class II, LVEF 23%). The patient experienced 2 more episodes of HF exacerbation. In the 26th week of pregnancy, in a primary prevention of sudden cardiac death and because of 2nd-degree AV block, an ICD was implanted. In the 32nd week of pregnancy a cesarean section was performed. A male infant was delivered. The patient made a good recovery and was discharged on the 7th postoperative day. The newborn was discharged after 4 weeks, in good general condition. At 1-year follow-up the patient presented NYHA class II.<br />

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  • Publisher Full Text
  • Authors

    Kryczka K, Dzielińska Z, Przybylski A, Szczudlik J, Dangel J, Konka M, Czajkowski K, Różański J, Bilińska ZT, Demkow M

    Source

    Medical science monitor : international medical journal of experimental and clinical research 18:5 2012 May pg CQ5-7

    MeSH

    Adult
    Digitalis
    Drug Therapy, Combination
    Enalapril
    Female
    Furosemide
    Heart Failure
    Humans
    Metoprolol
    Pregnancy
    Pregnancy Complications
    Spironolactone
    Ultrasonography, Doppler, Color

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    22534703