ABSTRACT
Introduction: Cardiac disease remains the largest single cause of maternal death. Whilst uncommon, left ventricular failure during pregnancy and delivery can be devastating to both mother and child. Echocardiography can play a significant role in rapidly establishing a diagnosis, guiding initial therapy and then monitoring response. Clinical vignettes: The history, presentation and management of three cases of peri-partum left ventricular failure is examined: stress cardiomyopathy in a 34 year old with twins, left ventricular dysfunction secondary to pre-eclampsia in a 22 year old with a singleton pregnancy and a true peri-partum cardiomyopathy in a 42 year old with IVF twins. The defining risk factors, presenting characteristics and echocardiographical findings for each pathology are highlighted. Conclusion: Echocardiography is playing an increasingly important role in the immediate assessment and management of left ventricular failure. This is especially true in the peri-partum woman, where establishing the correct therapy is both challenging and crucial due to the significant cardiovascular changes that occur around the time of delivery. To this end we believe that echocardiography should be rapidly available to guide the management of these patients by a multidisciplinary team made up of obstetricians, cardiologists, anaesthetists and intensive care physicians.
ABSTRACT
On awakening in the recovery room after a general anaesthetic for ear, nose and throat surgery, a 28-year-old woman reported central chest pain. She had received topical nasal cocaine solution preoperatively. She required intravenous opioids and sublingual glyceryl trinitrate before the pain settled. There was no evidence of significant myocardial injury and the patient was discharged later that day. The use of topical nasal cocaine solution in anaesthesia and its adverse myocardial effects are discussed.
