White Sarah, Welch Janna, Brown Lawrence H
Dell School of Medicine, University of Texas at Austin, USA.
Case Rep Emerg Med. 2015;2015:318645. doi: 10.1155/2015/318645. Epub 2015 Apr 15.
Background. Atrial fibrillation is a relatively uncommon but dangerous complication of pregnancy. Emergency physicians must know how to treat both stable and unstable tachycardias in late pregnancy. In this case, a 40-year-old female with a cerclage due to incompetent cervix and previous preterm deliveries presents in new-onset atrial fibrillation. Case Report. A previously healthy 40-year-old African American G2 P1 female with a 23-week twin gestation complicated by an incompetent cervix requiring a cervical cerclage presented to the emergency department with intermittent palpitations and shortness of breath for the past two months. EMS noted the patient to have a tachydysrhythmia, atrial fibrillation with rapid ventricular response. She was placed on a diltiazem drip, which was titrated to 15 mg/hr without successful rate control. Her heart rate remained in the 130s and the rhythm continued to be atrial fibrillation with RVR. Digoxin was then added as a second agent, and discussions about the potential risks of cardioversion in pregnancy ensued. Fortunately, the patient converted to sinus rhythm before cardioversion became necessary. The digoxin was discontinued; the diltiazem was also discontinued after the patient subsequently developed hypotension. "Why Should Emergency Physicians Be Aware of This?" New-onset atrial fibrillation is rare in pregnancy but can increase the mortality and morbidity of the mother and fetus if not treated promptly.
背景。心房颤动是一种相对不常见但危险的妊娠并发症。急诊医生必须了解如何治疗妊娠晚期的稳定和不稳定心动过速。在本病例中，一名40岁女性因宫颈机能不全和既往早产史行宫颈环扎术，现出现新发心房颤动。病例报告。一名40岁、既往健康的非裔美国女性，孕23周双胎妊娠，合并宫颈机能不全需行宫颈环扎术，因过去两个月间歇性心悸和呼吸急促就诊于急诊科。急救医疗服务人员（EMS）注意到患者有快速性心律失常，即伴有快速心室反应的心房颤动。给予患者地尔硫䓬静脉滴注，滴定至15毫克/小时，但心率控制未成功。她的心率维持在130多次，心律仍为伴有快速心室反应的心房颤动。随后加用洋地黄作为第二种药物，并就妊娠期间心脏复律的潜在风险进行了讨论。幸运的是，患者在需要心脏复律之前转为窦性心律。停用洋地黄；患者随后出现低血压后，地尔硫䓬也停用。“急诊医生为何应知晓此事？”新发心房颤动在妊娠中罕见，但如果不及时治疗，可增加母亲和胎儿的死亡率和发病率。
