Epidurals § tachicardia/arrythmia

[karen23]

I am about to deliver my second baby - with my first, I had a very bad epidural experience where they had a lot of trouble inserting it, etc.  They ended up giving me a lot of medication, on about 7 tries to get the epidural in, and I developed a very rapid heartbeat (165bpm) as well as a fever.  I am very worried that this situation may repeat itself - how much harm can this cause and it is likely that the epidural medication could cause my heart to race?  I have exercise related PVC's, although I didn't have any PVCs during delivery the first time (phew!!)  I should also mention I was very anxious at the time - could that have been a factor?   Thank you!  Karen

[Cleveland Clinic]

karen,

thanks for the post. good luck with the pregnancy.

An elevated heart rate can be a perfectly normal response to external stress. What you describe sounds like you had an elevated heart rate to either the discomfort or anxiety of the epidural, the pain associated with child birth or the fever you experienced during your hospitalization.

You've been through the expeience once which should help with all of the above. There would be no specific treatment for that type of elevation of heart rate except to minimize the stressors involved.

There is a small chance that it could have been a reaction to the medication. The timing of the event and associated factors such as rash, itching, or blood pressure fluctuation could hint that that would have been the case.


good luck with your new baby. Sleep alot now!

[dodgybeats]

Hi Karen,
I was very interested in your post as i am to give birth in 7 weeks time.  I am nervous about how my heart will react during labour as I have had a shocking time with PVCs and tachycardia during my whole pregnancy.  I was wondering if you had problems during your pregnancies and if you had any tests done? My doctors tell me its common and normal and so are not interested in doing any testing.  Thanks and good luck with your birth this time around!

[kat23]

Hi - I didn't have any problems during my first pregnancy, PVC wise - actually they really only started after the birth of my first baby.  The problem occured during labour, and I've always wondered if my rapid heartbeat should be a cause for concern.  At the time, my doctor seemed a little concerned, but not overly.

If you have PVC's, you've probably had all the tests, so I would think that if you've been checked out and given the a-ok, things will be ok in childbirth.  I have read that PVC's can sometimes be bothersome during pregnancies, although I haven't really had that experience either. I am only bothered during exercise, or occasionally, extreme stress.

Good luck with your birth as well - I hope it's PVC free, but if it's not, it will be ok anyway.  Other than my very rapid heartbeat and epidural, I actually enjoyed the labour experience - I hope you do too.

[kat23]

Hi!  The only PVC's I have had this pregnancy were before I knew for sure that I was pregnant.  I had a weird episode of skipped beats, but then got all sorts of symptoms as well - dizziness, nausea, shortness of breath - I actually went to my dr., who sent me to the ER where they decided there was nothing wrong with my heart.  After I realized I was pregnant, I put it down to hormones.  

Your delivery story sounds great - thanks for your encouragement and congrats if you are pregnant.  I have felt that with all extra weight/stress/blood volume in pregnancy, something might go wrong with my heart too, but so far so good.

[Mieke]

I have suffered with PVC's for many years and during my pregnancy the first 20 weeks were a nightmare, then all of a sudden they disappeared and for the last 20 weeks I was PVC free!  I have always wondered why this was so, and have thought it may have been the size of my stomach, perhaps moving something so my heart wasn't irritated?  (sometimes my PVC's seem to be postural and also after or during eating, but then not always, like everyone its sometimes very hard to pinpoint what actually causes them when they come out of the blue seemingly for no reason.)  I also find any infection such as a sore throat will make them worse.
After delivery my PVC's came back a few days later, when I saw the cardiologist that was when he diagnosed a mitral valve prolapse.  It seems a lot of people with MVP get PVC's do you know if you have the same?
Hope everything goes well for you.

[Shahrbanu]

My mother has irregular heart beat. She has bradycardia. 3 days ago doctor implanted a PaceMaker.  She is feeling very uncomfortable and getting more arythmia.  As soon as she lays down she gets more arythmia or any activity causes her to have arythmia.  What should she do.
Thanks,

[pookins]

Hi Karen,
I'm an anesthesiologist who was actually looking for something else when I stumbeled upon your post. As your OB probably told you, elevated heart rate is a normal part of pregnancy. And as the other Karen noted, stress can certainly elevate it to an even higher level, however, 165 is very fast and outside the usual rate we see.

One thing we do after we insert an epidural is to "test" it with a solution of lidocaine and epinephrine. If the epidural catheter inadvertantly punctured the membranes which contain the spinal fluid, the dose of lidocane given will be enough to show signs of a spinal anesthetic rapidly. The other possibility that we ant to test for is to make sure the catheter did not find it's way into a blood vessel. The epinephrine in the "test dose" tips us off to that possibility by, yes, elevating the heart rate. Since they had trouble with your epidural, it sounds like that might have happened to you. The epinephrine can also cause PVCs. The doctor should have pulled the catheter out, and tried insertion again at another level.

A fever can also cause increased heart rates. It is not unusual to have a low grade fever with a labor epidural because the epidural will not alow the nerves which control the sweat glands to function. Thus not only do you produce more heat from a higher metabolism during labor, but your body has less ability to get rid of it. Of course your OB will check to make sure there are no signs of chorioamniontis ifa fever does occur.