Management of palpitations and cardiac arrhythmia in pregnancy TOG 2019

Question 1

What % of women investigated for palpitations have ectopic beats or non-sustained arrhythmia?

Answer 1

50%

Question 2

What is the prevalence of arrhythmia in women with congenital heart disease?

Answer 2

4.7%

Question 3

If previous Tachyarrhythmia, what is risk of recurrence during pregnancy or 1 month after?

Answer 3

43%

Question 4

What changes are seen in ECG in normal pregnancy?

Answer 4

Inverted/flatterned T wave in leads III, V1-V3
Q wave leads II, III, ave
More frequent atrial/venrticular ectopic - 50-60%

Question 5

What symptoms increase risk of cardiac arrhythmia?

Answer 5

Hx known cardiac disease
Palpitated affected by sleeping

Question 6

How often does 24hr halter motor Dx clinically significant arrhythmia

Answer 6

3-24%

Question 7

Which is echo not indicated

Answer 7

Sx consistent with physiological changes in pregnancy
Isolated sinus tachycardia at time of S Sx on ECH
Infrequent ectopic beats without signs structural heart disease/innherited arrhythmia

Question 8

Who needs ECHO

Answer 8

Dx arrtymia
Audible heart murmur
Concern features: SOB
Structural heart disease
Prv chemo with cardiotocic agent
Family Hx inherited arrhythmia - Long QT, sudden cardiac death

Question 9

What is the most common non-benign arrhythmia in pregnancy?

Answer 9

SVT, most commonly caused by AV nodal re-entrant tachycardia

Question 10

Management of SVT

Answer 10

Valsalva
IV adenosine

Alternatives: Verapamil, metoprolol, direct current cardio version

Question 11

Atrial flutter rate of atria and ventricles beating

Answer 11

Atria 300 BPM
Ventricle 150 BPM
Saw tooth appearance

Question 12

If new AF or atria flutter in pregnancy what to consider?

Answer 12

Mitral stenosis
Metabolic or electrolyte abnormality

Question 13

How to cardiovert atrial fibrillation

Answer 13

Unstable - direct current cardio version

Stable (structural normal) IV flacainide/butilide

BB for prophylaxis
VTE prophylaxis

Question 14

Cardiac disease associated with ventricular tachycardias

Answer 14

Cardiac disease
Hypertrophic cardiomyopathy
Peripartum cardiomyopathy
Arrhythmogenic right ventricular cardiomyopathy
Congenital heart disease, including previous cardiac surgery
Valvular disease
Myocardial infarction

Inherited channelopathies
Long QT syndrome

Question 15

Cardioversion for ventricular arrhythmia

Answer 15

Instability - electrical cardio version

Stable - Sotalol/flexanide

Question 16

Prophylaxis against VT

Answer 16

BB
Amiodarone
ICD

Question 17

What SE do you need to consider for amiodarone?

Answer 17

In pregnancy and prolonged used - fetal thyroid abnormality, FGR, PTL

Breastfeeding - neonatal hypothyroidism

Question 18

Long QT syndrome is associated with which ventricular arrhythmia

Answer 18

Tosades de pointes
Increased in risk in postnatal period

Question 19

What medication should be given to Long QT syndrome

Answer 19

B blocker
Avoid electrolytes distrunace, hyperemsis high risk

Question 20

What commonly prescribed drugs should not be given to patients with Long QT Syndrome

Answer 20

Prochlorperazone
Ondansetron
Trimethoprim
Erythromycin

Question 21

Risk of sudden infant death in LQTS

Answer 21

10%, review by neonatal team before discharge