Characterization of cardiac arrhythmias and maternal-fetal outcomes in pregnant women: A prospective cohort study.

INTRODUCTION AND OBJECTIVES: Cardiovascular disease is a common cause of morbidity and mortality in pregnant women. Arrhythmias are common complications during pregnancy; however, the data are limited. Our goal was to characterize the epidemiology, clinical presentation, and impact of cardiac arrhythmias on maternal-fetal outcomes. METHODS: A prospective cohort study from the Colombian Registry of Pregnancy and Cardiovascular Disease was carried out from 2016 to 2019. All patients with tachyarrhythmia or bradyarrhythmia and a minimum follow-up of six months after delivery were included. The primary outcome was a composite of cardiac events defined as pulmonary edema, symptomatic sustained arrhythmia requiring specific therapy, stroke, cardiac arrest, or maternal death. Secondary outcomes were other cardiac, neonatal, and obstetric events. RESULTS: Arrhythmias were the most common cause of referral to our dedicated cardio-obstetric clinic. A total of 92 patients were included, mean age 27±6 years; 8.7% had previous structural heart disease, and cardiology consultation was delayed in 79.4%. The most common arrhythmias were premature ventricular contractions (33%) and paroxysmal reentrant supraventricular tachycardias (15%); 11 patients (12%) had cardiac implantable electronic devices. Cardiac events occurred in 18.4% of patients, obstetric events occurred in 6.5%, and one caesarean was indicated in the context of symptomatic severe mitral stenosis. Adverse neonatal outcomes were observed in 24.3% of newborns. CONCLUSIONS: Arrhythmias were the most common cause of referral to a dedicated cardio-obstetric clinic; most had a benign course. Adverse maternal cardiovascular outcomes were significant and there was a high rate of obstetric and neonatal adverse events, underlining the importance of multidisciplinary care.

Diagnóstico por imágenes / Diagnoses through images

Paciente de 23 años, quien fue remitido a la Fundacion Clinica Valle del Lili por cuadro de 10 dias de evolucion, iniciado luego de ser sometido a extraccion de la cordal inferior izquierda en un consultorio dental. Comienza con dolor y edema en el area del procedimiento, recibe Dicloxacilina y otros antibioticos con incremento de dolor y el edema. Aparece halitosis severa, dolor toracico y dificultad respiratoria progresiva. Al ingreso con una frecuencia respiratoria de 56 por minuto y cardiaca de 97 por minuto, tension arterial de 108/80 y temperatura de 37º C. Presentaba gran edema de cuello y un absceso periodontal izquierdo con salida de abundante material purulento fetido. A la auscultacion presentaba marcada hipoventilacion basal derecha.