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23 April 2012

Therapeutic challenges and management of heart failure during pregnancy (part I)

Karolina Kryczka, Zofia Dzielińska, Andrzej Przybylski, Julia Szczudlik, Joanna Dangel, Marek Konka, Krzysztof Czajkowski, Jacek Różański, Zofia T. Bilińska, Marcin Demkow

DOI: 10.12659/MSM.882716

Med Sci Monit 2012; 18(5): CQ5-7

Abstract

Therapeutic management in pregnant patients with heart failure still remains a challenge, even though in most pregnant women with cardiac diseases an outcome is good. A 32-year-old woman, 17 weeks pregnant, was admitted to hospital with heart failure (HF) NYHA class III/IV. Echocardiography revealed enlarged LV, LVEF 13%, significant mitral insufficiency and pulmonary hypertension. The patient wished to continue the pregnancy. In a life-threatening condition, metoprolol, enalapril, spironolactone (for 5 days), furosemide, and digitalis were administered. Enalapril was continued for 42 days. Then the patient was switched to a dihydralazine and isosorbide mononitrate regimen. The fetus was controlled ultrasonographically. In the 19th week of pregnancy, the patient’s condition improved (NYHA class II, LVEF 23%). The patient experienced 2 more episodes of HF exacerbation. In the 26th week of pregnancy, in a primary prevention of sudden cardiac death and because of 2nd-degree AV block, an ICD was implanted. In the 32nd week of pregnancy a cesarean section was performed. A male infant was delivered. The patient made a good recovery and was discharged on the 7th postoperative day. The newborn was discharged after 4 weeks, in good general condition. At 1-year follow-up the patient presented NYHA class II.

Keywords: Pregnancy, Pregnancy Complications - therapy, Metoprolol - therapeutic use, Heart Failure - physiopathology, Furosemide - therapeutic use, Enalapril - therapeutic use, Drug Therapy, Combination, Digitalis, Spironolactone - therapeutic use, Ultrasonography, Doppler, Color

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