Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore.
BMJ Case Rep. 2021 Sep 7;14(9):e243805. doi: 10.1136/bcr-2021-243805.
We report a case of a previously fit woman who presented at 26 weeks into her fourth pregnancy with a dry cough. Following a nasopharyngeal swab, she was diagnosed with a infection, and treated with antibiotics. A chest X-ray showed right atrial dilatation and an echocardiogram was scheduled outpatient. However, after re-presenting with worsening cough and dyspnoea, an inpatient echocardiogram was performed which suggested elevated pulmonary pressures with significant tricuspid regurgitation, as confirmed by subsequent cardiac catheterisation. She had an elective caesarean section at 34 weeks and underwent repeat right heart catheterisation which revealed persistent, and likely pre-existing, pulmonary arterial hypertension. This case highlights the importance of thorough assessment of non-obstetric symptoms in pregnancy in formulating alternative differentials, even after a diagnosis has been made, to prevent potentially life-threatening conditions from being missed. It also shows that although often associated, respiratory and cardiac causes may coexist separately.
我们报告了一例先前身体健康的妇女，她在怀孕第四个周期的第 26 周时出现干咳症状。进行鼻咽拭子检查后，她被诊断患有 感染，并接受了抗生素治疗。胸部 X 光显示右心房扩张，并安排了门诊心脏超声心动图检查。然而，她再次因咳嗽和呼吸困难加重而重新就诊，随后进行了住院心脏超声心动图检查，结果提示肺动脉压力升高，三尖瓣反流严重，随后的心脏导管检查也证实了这一点。她在 34 周时进行了选择性剖宫产，并进行了重复的右心导管检查，结果显示持续存在且可能是先前存在的肺动脉高压。这个病例强调了在怀孕期间全面评估非产科症状的重要性，即使已经做出诊断，也要考虑其他可能的鉴别诊断，以防止潜在的危及生命的情况被遗漏。它还表明，尽管呼吸道和心脏原因通常相关，但它们也可能单独存在。
