Slightly enlarged heart and severe mitral regurgitaion

[threesetsoftwins]

I'm a 37 year old mom of 13 children. I'm physically active and I have never had any health problems until 2 weeks ago--during the birth of our third set of twins. My twins had a rare condition called TTTS (twin-to-twin-transfusion-syndrome) in which the babies share too many blood vessels through their common placenta. One of the babies was in heart failure for 2 weeks before they were born at 24 weeks gestations (they are stable, thank God). I had been given Digoxin for the babies' heart failure. My levels rose to toxic levels and during the c-section I had terrible, chaotic arrhythmias. So bad, that the nurses requested a defibrillator. They didn't have to use it. For the next 2 days I felt weak and had occasional PVCs. I was put on metoprolol and monitored around th clock.
Two days after the episode (and after having been given potassium and mag. IVs), I agreed to have an echocardiogram done (mind you, all my ekgs had been normal). The echo showed a severe mitral valve regurgitation, EF of 50% and a "slight heart enlargement" according to the cardiologist. My cardiologist thinks it might be pregnancy related (PPCM). A CT scan 2 days ago showed a 100% normal heart but can't detect regurgitation (EF 47%).
My question is:
1.) Can a digoxin overdose in combination with tachycardia during the pregnancy and a difficult c-section delivery cause a heart to "slightly enlarge", pulling the mitral valve out of place? If so, how long will the recovery take? I feel almost back to normal (feeling stronger every day).
2.)Can the hemodynamics of a twin pregnancy cause MR?
    

[CCF-M.D.-MJM]

Hello,

Wow -- that is a lot of kids.  Sorry to hear about the complications of your most recent pregnancy.  


1.) Can a digoxin overdose in combination with tachycardia during the pregnancy and a difficult c-section delivery cause a heart to "slightly enlarge", pulling the mitral valve out of place? If so, how long will the recovery take? I feel almost back to normal (feeling stronger every day).

Tachycardia can cause the heart to enlarge, but usually this is a significant sustained tachycardia (rates in the 120 range or higher).  Pregnancy significantly increases  your blood volume and can cause valves that leak minimally at baseline to leak much more during pregnancy.  An EF of 45-50% is only minimally decreased.  It sounds like medical management and follow up with subsequent echo's is probably the best way to proceed.  If you aren't having symptoms, it is reasonable to repeat an echo in 2-3 months.  If you start having symptoms, you should be reevaluated sooner.


2.)Can the hemodynamics of a twin pregnancy cause MR?

The increased blood volume associated with pregnancy can make leaking valves worse.  Give it some time -- a couple months if you aren't having symptoms -- and recheck the echo.

I hope this helps.  Our thoughts are with you and your family. Thanks for posting.

[dande4]

Sorry to hear about the babies problem but glad to hear they are both doing well. Sorry for you too for having to go through all this. You must be one strong Mom,,13 children,,,wow,,kudos to you and congratulations!

I'm glad to read that your ct scan was looking good. Hopefully it was all just pregnancy induced especially now that you are feeling stronger each day..that is great.

This is not much of a post to help you, but I just wanted to congratulate you on the twins and wish you and them the best.

[CollegeGirl143]

13 Kids?! thats amazing. It must have been really tough having heart problems and being prengnant all at the same time :(.. But at least you're feeling better! you seem like a tough woman, hang in there and im sure everything will be great!

[texas2step]

Bless you..Bless you...Bless You.  I hope you have some help.

My sister had similar after the birth of her still born.  She was followed up for months and eventually her heart normalized and her EF fraction went up into the 60's.   Follow up regulary with the doctors and take care of yourself.   Wish you and your family all the best.

[anacyde]

Apparently my comment was erased, for what reason I can't possibly comprehend.

Go here: www.amothersheart.org.  It is a wonderful site for women with PPCM and you can find a lot of information on the condition, as well as a support forum.