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SVT case report - POAG

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									Case Presentation



       Rob Price
Consultant Anaesthetist
Royal Devon and Exeter
                      Case
   Saturday night
   28 yr old
   Term
   Presents to labour ward with tachycardia 150
   Not in labour
   No compromise
   CTG normal
                        PMH
   Primip
   Fit and well
   Mild asthma
   No history of palpitations or collapse
                            Medics
   Verapamil 80mg po and review
   Cardiology advice sought in the morning
       Stop verapamil
       Not for further systemic drugs
       If does not cardiovert for dc cardioversion under GA
       Specifically asked about adenosine
           Medics no because of asthma
           Cardiology no because of baby
                 Labour ward
   Remained uncompromised
   CTG normal
   Fasted from lunchtime
   Previous GA ok
   Airway ok
   BMI ok
   Concerted vagotonic manoeuvres unsuccessful
                      Plan
•   Fully monitored in theatre
•   CTG
•   Obstetricians scrubbed and theatre team
    ready
•   Consented for dc cardioversion under GA+/-
    caesarean
•   Paediatricians present
•   Medics to perform cardioversion
                   Outcome
•   Induction uneventful
•   Cardioversion unsuccessful times 2
•   Heart rate increased to 180, BP maintained
•   Further discussion with cardiologists
•   CTG reduced variability, normal baseline
•   Obstetricians keen to perform caesarean
                     Outcome
•   Adenosine given and cardioverted at 12mg
•   Obstetricians decided to deliver baby by
    caesarean
     –   Concerned about CTG
     –   Worried that mother may be compromised by
         further episodes of SVT precipitated by labour
                     Outcome
•   Caesarean
     –   1200ml brisk blood loss
     –   Baby fine
     –   Mother recovered
•   No further SVT
           Pregnancy and SVT
•   Some authors report increased incidence but
    others a decrease
•   Increased oestrogen and beta hCG
•   Increased sensitivity to catecholamines and
    circulating adrenaline
•   Increased resting heart rate and cardiac
    output circulating volume and myocardial
    stretch
                     Literature
•   Case reports
     –   Adenosine first line, safe for baby although
         transient heart block may occur
     –   DC cardioversion also safe for baby, very little
         current passes through the uterus
     –   Metoprolol also safe and effective
                     Issues
•   Unusual presentation of common disorder
•   3 specialists with different perspectives, 2
    patients
•   Conflicting advice strongly expressed
•   How to decide what to do ?

								
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