##plugins.themes.bootstrap3.article.main##

Kavidha Mohan Koh Hock Peng Jivan R Nagarajah Dr Muhammad Yusof Muharam

Abstract

Introduction

Pregnancy has been identified as a risk factor for paroxysmal supraventricular tachycardia (PSVT) as reported in medical literatures. Treatment of PSVT during pregnancy is crucial to protect both mother and fetus. Guidelines have recommended IV Adenosine as the first line treatment. However, challenges arise when there is a need to opt for the safest treatment based on concurrent emergencies of a presenting patient.

Case description

A 30-year old primigravida with underlying bronchial asthma and 18 weeks pregnant was presented to the health clinic with chief complaints of dyspnea and palpitation for one day. During initial examination, she was having rhonchi and electrocardiogram showed stable paroxysmal supraventricular tachycardia (PSVT). Patient was referred to the Emergency Department (ED) for further management.

On arrival, cardiac monitor still shows PSVT.  She did not respond to carotid massage and Modified Valsalva maneuver. Her heart rate was between 160-180 bpm with blood pressure of 103/73 mmHg upon arrival to the ED. She was given IV Verapamil 2.5mg with additional 4 doses over the next 3 hours giving a total dose of 12.5mg, but was unsuccessful. Subsequently, after consultation with Medical team, IV Adenosine 6mg was administered with no success and without worsening of bronchospasm.

The patient was then given synchronized electrocardioversion with 50J but failed on the first attempt. Finally, PSVT resolved after another electrocardioversion with 100J was given.

Discussion & Conclusion

This case illustrates the use of IV Verapamil instead of IV Adenosine as the initial treatment as IV Adenosine is best avoided during acute exacerbation of bronchial asthma to prevent worsening of bronchospasm. Although IV Verapamil failed for our patient, it has been reported with more than 70% successful conversion rate .All treatment options must ensure effectiveness and safety to the expecting mother and fetus.

##plugins.themes.bootstrap3.article.details##

Keywords

SVT, pregnancy, AEBA, Verapamil, Adenosine

References
1. Nina Ghosh, Adriana Luk, Christine Derzko, Paul Dorian, Chi-Ming Chow. The Acute Treatment of Maternal Supraventricular Tachycardias During Pregnancy: A Review of the Literature. J Obstet Gynaecol Can 2011;33(1):17–23.
2. Page RL, Joglar JA, Al-Khatib SM, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NAM 3rd, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen W-K, Tracy CM. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2015;132:e000-e000.
3. Marinan Gaviola, Meghan Groth. Adenosine in Reactive Airway Disease [Internet]. United States: ALiEM; 2015. Available from
https://www.aliem.com/2015/03/adenosine-in-reactive-airway-disease/
4. Naushewan K Burki, Mahmud Alam, Lu-Yuan Lee. The Pulmonary Effects of Intravenous Adenosine in Asthmatic Subjects. Respiratory Research 2006, 7:139
5. Rachael Cordina, Mark A McGuire. Maternal Cardiac Arrhythmia during Pregnancy and Lactation. Obstetric Medicine. 2010; 3:8-16.
6. Tan HL, Lie KI. Treatment of Tachyarrhythmia during Pregnancy and Lactation. European Heart Journal. 2001; 22, 458-464 .
Section
EMAS Meeting 2018 Abtracts