Sebastian Abey, Bhaskar Emmanuel, Moorthy Swathy, M Lakshmi
Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND.
General Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND.
Cureus. 2024 Jul 8;16(7):e64109. doi: 10.7759/cureus.64109. eCollection 2024 Jul.
A primigravida at 36 weeks with gestational diabetes mellitus and hypothyroidism and no prior chronic medical illness was admitted for safe confinement. A cesarean section was required to deliver the baby with breech presentation complicated by a slow progression of labor. Asymptomatic sinus bradycardia with a heart rate of 40 per minute was observed during the induction of anesthesia. Before bupivacaine administration for spinal anesthesia, she was administered pantoprazole 40 mg and ondansetron 4 mg intravenously. ECG recording showed a type 1 Mobitz second-degree heart block. Follow-up ECG showed progression of heart block to type 2 Mobitz second-degree heart block. The second-degree heart block persisted for 16 hours, during which the patient was asymptomatic, and the ventricular rate was maintained at a range of 60-80 per minute. After normalization of rhythm, the patient was observed in the ICU. She received another dose of ondansetron 4 mg intravenously for vomiting, and the heart block recurred. The rhythm disturbance was attributed to ondansetron. Her rhythm normalized after 36 hours, and she was subsequently discharged home three days later.
一名36周妊娠的初产妇，患有妊娠期糖尿病和甲状腺功能减退症，既往无慢性病史，因安全分娩入院。因臀位分娩且产程进展缓慢，需行剖宫产。麻醉诱导期间观察到无症状性窦性心动过缓，心率为每分钟40次。在给予布比卡因进行脊髓麻醉前，静脉给予她40毫克泮托拉唑和4毫克昂丹司琼。心电图记录显示为1型莫氏二度房室传导阻滞。后续心电图显示房室传导阻滞进展为2型莫氏二度房室传导阻滞。二度房室传导阻滞持续了16小时，在此期间患者无症状，心室率维持在每分钟60 - 80次。心律恢复正常后，患者在重症监护病房接受观察。她因呕吐又静脉注射了一剂4毫克昂丹司琼，随后房室传导阻滞复发。节律紊乱归因于昂丹司琼。36小时后她的心律恢复正常，三天后出院回家。
