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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

Dextrocardia presenting as sustained atrial tachycardia refractory to medical management during term labor in a nulliparous parturient

Abstract Number: S 63
Abstract Type: Case Report/Case Series

Mary DiMiceli MD1 ; Mary DiMiceli MD2; Michael A Fishman MD, MBA3; Aymen Alian MD4

A 21y/o G1P0 previously healthy female admitted in active labor at 38wks developed narrow complex tachycardia after administration of terbutaline for tocolysis secondary to sustained fetal HR deceleration. Multiple interventions proved unsuccessful, except for transient normalization with adenosine. The patient delivered with vacuum-assistance and immediately postpartum a full work up was performed. A cardiac echo was negative and a chest x-ray at that time demonstrated dextrocardia and a gastric bubble under the right hemi-diaphragm suggestive of situs inversus. The patient was started on a diltiazem infusion, loaded with flecainide and transitioned to oral diltiazem. During pregnancy women experience a variety of physiological changes, and to the parturient with pre-existing cardiac disease, whether known or not, none is as significant as the hemodynamic and cardiovascular changes that occur. These physiological changes may also precipitate new onset cardiac disease. The most common cardiac complication that occurs in pregnancy is arrhythmias, with or without underlying structural heart disease, and may be secondary to the combination of a hyperdynamic state, electrolyte disturbances and an altered hormonal environment. Iatrogenic causes include administration of medications such as tocolytics (terbutaline) or oxytocin. The use of terbutaline in this patient already in labor, with an unknown congenital cardiac condition may have induced the arrhythmia. Our patient was found to have dextrocardia on CXR. Dextrocardia, a congenital cardiac position anomaly in which the heart is located in the right hemi-thorax and the axis of the heart is rotated so that the apex is pointed right instead of the left. There are two major types--patients with the “mirror image” type, such as our patient, the conduction system of the heart is also abnormal. As a result, the development of arrhythmias in dextrocardia is more likely secondary to the abnormal conduction system. Again, it is interesting to note that this patient did not have ECG findings consistent with dextrocardia, but CXR was positive for the cardiac silhouette in the right hemi-thorax and gastric bubble in right upper quadrant consistent with dextrocardia situs inversus. In regards to the recalcitrant nature of the arrhythmia, this likely may have been a consequence of her dextrocardia. RH Anderson. The conduction tissues in congenitally corrected transposition. Ann Thor Surg. 2004;77:1881-1882.

SOAP 2013