Unbound MEDLINE

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 />

Authors

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

Institution

Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland. kryczka_ka@yahoo.com

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