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Heart Disease (Expert Forum)
Ventricular tachycardia in pregnancy
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Ventricular tachycardia in pregnancy
by rkeba, Jul 21, 2006 12:00AM
Alleluia I got in!!!
I am 35 year old in my 3rd pregnancy with MVP, episodes of syncope/unsustained ventricular tachycardia & history of sudden death paternally at 50. For the entire duration of this pregnancy, I have been tachycardic with episodes of PVC that have increased in frequency & duration at about 28 weeks. The last syncope I was in the hospital on a heart monitor after 36 hours of tachycardia, experienced an extreme wave of nausea and looked over at the monitor to see my rhythm change from tachycardia of 120bmp to 156bmp & become extremely erratic twisting on its axis. I noted it for a screen & a half before I passed out (approx 20-25 beats). When I came to I went into adrenaline shock & began shaking violently and was put on oxygen. Unfortunately, I was not hooked up to an ECG & it wasn't recorded. Really concerned that I should be put on a rx immediately as I have continued to have these incidents of nausea & near syncope conservatively 35-40 times over the 2 weeks since release & a dramatic increase in PVC to 25-35 times daily. I have pinpointed the rhythm most similar to mine as torsades de pointes & note its’ potentially life-threatening nature. Would it not be prudent to start therapeutic doses of magnesium sulfate or vepramil? I note that associated long QT syndrome can become problematic after birth if not treated in pregnancy & post-partum. Is this true & what can be done to counteract it? Can long periods of tachycardia increase damage to the mitral valve? Have an OB apt today going to plead my case there taking in research (See yesterdays'post!)
I am 35 year old in my 3rd pregnancy with MVP, episodes of syncope/unsustained ventricular tachycardia & history of sudden death paternally at 50. For the entire duration of this pregnancy, I have been tachycardic with episodes of PVC that have increased in frequency & duration at about 28 weeks. The last syncope I was in the hospital on a heart monitor after 36 hours of tachycardia, experienced an extreme wave of nausea and looked over at the monitor to see my rhythm change from tachycardia of 120bmp to 156bmp & become extremely erratic twisting on its axis. I noted it for a screen & a half before I passed out (approx 20-25 beats). When I came to I went into adrenaline shock & began shaking violently and was put on oxygen. Unfortunately, I was not hooked up to an ECG & it wasn't recorded. Really concerned that I should be put on a rx immediately as I have continued to have these incidents of nausea & near syncope conservatively 35-40 times over the 2 weeks since release & a dramatic increase in PVC to 25-35 times daily. I have pinpointed the rhythm most similar to mine as torsades de pointes & note its’ potentially life-threatening nature. Would it not be prudent to start therapeutic doses of magnesium sulfate or vepramil? I note that associated long QT syndrome can become problematic after birth if not treated in pregnancy & post-partum. Is this true & what can be done to counteract it? Can long periods of tachycardia increase damage to the mitral valve? Have an OB apt today going to plead my case there taking in research (See yesterdays'post!)
Doctor's Answer
by CCF-M.D.-MJM, Jul 21, 2006 12:00AM
Hello,
congrats on your pregnancy.
Would it not be prudent to start therapeutic doses of magnesium sulfate or vepramil?
This is a tough question. Your doctors must not think this is torsodes are they wouldn't have sent you home? You episodes sound like they are frequent enough that you should be able to capture them on monitor -- holter, event monitor, or in patient monitor. Verapamil doesn't help torsodes. Magnessium has some benefits in shortening the qt. You really should talk to your doctor about your concerns (I am assuming you already have). Consider a second opinion if your doctor cannot reassure you enough that your rhythm isn't life threatening.
Is this true & what can be done to counteract it?
If you have long QT syndrome, magnessium can shorten the QT interval. Beta blockers are used in some patients with long QT syndrome -- but can cause fetal bradycardia. The real question is do you have long QT syndrome and is this torsodes -- the other questions need addressed only if this is truly torsodes. Again, if you aren't satisfied with one opinion, obtain a second opinion.
Can long periods of tachycardia increase damage to the mitral valve?
Tachycardia does not damage the mitral valve.
Have an OB apt today going to plead my case there taking in research--
Good luck with your appoinment and thanks for posting.
congrats on your pregnancy.
Would it not be prudent to start therapeutic doses of magnesium sulfate or vepramil?
This is a tough question. Your doctors must not think this is torsodes are they wouldn't have sent you home? You episodes sound like they are frequent enough that you should be able to capture them on monitor -- holter, event monitor, or in patient monitor. Verapamil doesn't help torsodes. Magnessium has some benefits in shortening the qt. You really should talk to your doctor about your concerns (I am assuming you already have). Consider a second opinion if your doctor cannot reassure you enough that your rhythm isn't life threatening.
Is this true & what can be done to counteract it?
If you have long QT syndrome, magnessium can shorten the QT interval. Beta blockers are used in some patients with long QT syndrome -- but can cause fetal bradycardia. The real question is do you have long QT syndrome and is this torsodes -- the other questions need addressed only if this is truly torsodes. Again, if you aren't satisfied with one opinion, obtain a second opinion.
Can long periods of tachycardia increase damage to the mitral valve?
Tachycardia does not damage the mitral valve.
Have an OB apt today going to plead my case there taking in research--
Good luck with your appoinment and thanks for posting.
Related discussions
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Chest pain and diverse symptoms (9 replies):I am a 23 year old male with no family history of heart ...[more]
My personal observation/opinion only. The key is Do you have a documented family history of long QT syndrome? Is this your cause for concern? As far as I know MOST cases of long qt can be diagnosed by an ECG and family history.
Your family history of SCD , Was it it related to coronary heart disease or some other cardiac anomaly? Just a few questions I'd have in mind. I'm not a doctor, just my personal observation/opinion. Good luck and a safe labor and delivery.
Unfortunately, the cardiac monitor was not recording at the time of the last syncope episode, so the event was not on paper. The blood work came back with my D-dimer levels "pathological", as the dear Doc put it, and I was given heparin shots immediately and a CT was done of my lungs the next day. As a result of pulmonary edema, the Dr. didn't look any further as to the causes of the arrhythmias.
However, when the tests came back clear, we did have conversations about what I saw on the monitor. He has agreed that a new Echo and holter would be a good idea as the last one was 5 months ago before the symptoms went into high gear.
In my appt. with the OB yesterday, he was quite concerned about the cardiac issues and immediately called for a referral to the cardiologist. He is concerned because my iron and magnesium levels are low, even though I am on supplements for both above the prenatals I take and I've barely gained any weight (12 lbs and baby is 5lbs)at 34 weeks.
In consort with the episodes of passing out (which I was unfortunate/fortunate to have another one during the ultrasound yesterday) the extra blood/cardiac demands that the Placenta Abruptio has caused since it started bleeding at 16 weeks and the hemodynamic challenges of labour and birthing, he wants to evaluate what measures need to be taken, if necessary.
As for the cause of the SCD, it has all been arrhythmia and cardiac-structure related. I know of no problems with coronary blockage issues.
1) What are the main risks of Catheter ablation (as a part of this procedure they will be doing an EP study, because it was never really determined whether this tachycardia is from the upper or lower chambers of the heart--what are the risks? the doctor spoke of a few, but he was very technical.
2) What risks would face my child (should I decide to not get the procedure, and eventually become pregnant). I have heard there is limited research (limited to animal, not human studies. My Dr. said that my baby would likely just have a low birth weight, but how does he really know this without proven human research?
3) What would/could I face in labour/delivery, woudl I still be able to have an epidural (my first birth had no complications, carried to full term, and delivered vaginally).
I have been back and forth about getting this procedure (scary) and want to know the risks for myself, and also what risks the Metorpolol would cause to a baby (also scary, and do not want to put any child at risk of any side effects).
Please advise, and can you tell me what your credentials are? Just for my own information and to know who this information is coming from.
Tkaya