Successful management of a patient with severe brady-arrhythmia in peripartum period

Aditi Tandon, Meena Satia, Vijaya Badhwar


Pregnancy is a normal physiological state with hyperdynamic circulation that is characterised by important physiological changes, many of which take place in the cardiovascular system. Few patients with physiological bradycardia may, in the second trimester, feel symptomatic as their blood pressure drops due to a reduction in systemic vascular resistance however, treatment is rarely required. Pathological bradycardia in pregnant women is rare and usually secondary to either Congenital heart block, Myocarditis, or Severe Hypocalcaemia with an incidence as low as 1:20 000 women. Authors present a rare case of severe bradycardia during peripartum period who required LSCS in view of IUGR with Anhydroamnios. On admission her general condition was good her pulse was 42 beats per mins and BP was 170/100 mm of Hg with 1+ protinuria.  A clinical impression of preeclampsia was made. ECG showed sinus bradycardia with no irregularity. 2 DEcho showed no structural lesion in the heart and normal functional capacity so dilated peripartum cardiomyopathy was ruled out. Her serum electrolytes were normal and serum calcium and magnesium was markedly reduced which was corrected. Post operatively on day 4 pulse was mor than 60 and she was transferred out of ICU. The ECG performed on day 6 was normal.


Arrhythmia, Bradycardia, Hypotensive syndrome, Myocarditis

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Dawn Adamson and Catherine Nelson-Piercy. (2007) Managing palpitations and arrhythmias during pregnancy. Heart 2007;93(12):1630-6.

Blackburn TS, Lee LD. Cardiovascular system. In: Eoyang T, ed. Maternal, Fetal and Neonatal Physiology: a clinical Perspective. Philadelphia: WB Saunders, 1992:201-12.

Leung CY, Brodsky MA. Cardiac arrhythmias and pregnancy: diagnosis and management of maternal and fetal disease. In: Elkayam U, Gleicher N, eds. Cardiac Problems in Pregnancy. 3rd ed. New York: Wiley-Liss, 1998:155-75.

Robson SC, Hunter S, Boys RJ, Dunlop W. Serial study of factors influencing changes in cardiac output during human pregnancy. Am J Physiol. 1989; 256(4):H1060-5.

Hidaka N, Chiba Y, Kurita T, Satoh S, Nakano H. Is intrapartum temporary pacing required for women with complete atrioventricular block? An analysis of seven cases. BJOG. 2006;113(5):605-7.

Shen CL, Ho YY, Hung YC, Chen PL. Arrhythmias during spinal anesthesia for Cesarean section. Can J Anaesth. 2000;47(5):393-7.

Dalvi BV, Chaudhuri A, Kulkarni HL: Therapeutic guidelines for congenital complete heart block presenting in pregnancy. Obstet Gynecol.1992;79(5 pt 2):802-4.

Jaffe R, Gruber A, Fejgin M. Pregnancy with an artificial pacemaker. Obstet Gynecol.1987 42(3):137-9.

Hair TE Jr, Eagan JT, Orgain ES. Paroxysmal ventricular tachycardia in the absence of demonstrable heart disease. Am J Cardiol. 1962; 9(2):209-14.

Hubbard WN, Jenkins BA, Ward DE. Persistent atrial tachycardia in pregnancy. Br Med J (Clin Res Ed). 1983;287(6388):327.

Brodsky M, Doria R, Allen B, Sato D, Thomas G, Sada M. New-onset ventricular tachycardia during pregnancy. Am Heart J. 1992;123(4):933-41.

Shotan A, Ostrzega E, Mehra A, Johnson JV, Elkayam U. Incidence of arrhythmias in normal pregnancy and relation to palpitations, dizziness, and syncope. Am J Cardiol. 1997;79(8):1061-4.

Romem A, Romem Y, Katz M, Battler A. Incidence and characteristics of maternal cardiac arrhythmias during labor. Am J Cardiol 2004; 93:931-3. Comment in: Am J Cardiol. 2005;95(7):435.

Upshaw CB Jr. A study of maternal electrocardiograms recorded during labor and delivery. Am J Obstet Gynecol 1970;107(1):17-27.

Hall MH. Mortality associated with elective caesarean section. BMJ 1994;308(6943):1572.