Whooping cough complicating pulmonary hypertension in pregnancy

2021 ◽  
Vol 14 (9) ◽  
pp. e243805
Author(s):  
Tiffany Tuck Chin Wong ◽  
Yang Huang Grace Ng ◽  
Limin Yan ◽  
Ann Wright
Keyword(s):  
Whooping Cough ◽  
Elective Caesarean Section ◽  
Right Atrial ◽  
Nasopharyngeal Swab ◽  
Hypertension In Pregnancy ◽  
Right Heart Catheterisation ◽  
Life Threatening ◽  
Chest X Ray ◽  
Pulmonary Arterial ◽  
In Pregnancy

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 pertussis 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.

scholarly journals Pulmonary hypertension in pregnancy

2021 ◽  
Vol 10 (3) ◽  
pp. 1259
Author(s):  
K. Durga ◽  
S. Yuvarajan ◽  
R. Praveen ◽  
Antonious Maria Selvam ◽  
Yashoda . ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Phosphodiesterase Inhibitors ◽  
High Morbidity ◽  
Therapeutic Abortion ◽  
Hypertension In Pregnancy ◽  
Mean Pulmonary Arterial Pressure ◽  
Right Heart Catheterisation ◽  
Receptor Blockers ◽  
Pulmonary Arterial ◽  
In Pregnancy

Pulmonary hypertension is defined as an increase in mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest as assessed by right heart catheterisation. Pulmonary hypertension in pregnancy is known to be associated with significantly high morbidity and mortality rate which ranges between 30% and 56%. So during pregnancy, efforts to be made to diagnose common medical ailments that can be complicated by pulmonary hypertension. Bedside 2D Echo and thoracic ultrasound are the strongly recommended in these patients to diagnose early and prevent the devastating complications. Relevant blood investigations need to be sent to diagnose the underlying etiology and to assess the prognosis. Cardiac catheterization is the gold standard investigation of choice for pulmonary hypertension. But it is 1 performed in very few cardiac centres in developing countries. In India diagnosis largely depends on echocardiography. It should be made clear to women at the time of their PAH diagnosis that pregnancy is not recommended due to the high maternal and fetal risks. If a woman with known PHT become pregnant, counselling should be given for therapeutic abortion. If they are willing for therapeutic abortion, it should be done before 22 weeks of gestation. All women with PHT should be initiated on PAH specific therapies (prostanoids, ccbs, phosphodiesterase inhibitors) except endothelin receptor blockers as it is teratogenic. Pregnancy in PAH is difficult to manage and needs mutidisciplanary team. Pregnancy is not recommended in women with PAH and appropriate counselling to be done to the mother and their relatives. 

Pulmonary Arterial Hypertension in Pregnancy

2021 ◽  
Vol 39 (1) ◽  
pp. 109-118
Author(s):  
Wenners Ballard ◽  
Brittany Dixon ◽  
Colleen A. McEvoy ◽  
Amanda K. Verma
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Hypertension In Pregnancy ◽  
Pulmonary Arterial ◽  
In Pregnancy

scholarly journals Pulmonary Arterial Hypertension in Pregnancy: Outline of Multidisciplinary Care

2019 ◽  
pp. 346-353 ◽  
Author(s):  
Patel MB ◽  
Kellerhals S ◽  
Horton JP ◽  
Fisher MR ◽  
Krishna I ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Postpartum Period ◽  
Multidisciplinary Care ◽  
Management Process ◽  
Hypertension In Pregnancy ◽  
Pulmonary Arterial ◽  
Guide Care ◽  
In Pregnancy ◽  
Group 1

Pulmonary Arterial Hypertension in pregnancy causes significant maternal and fetal morbidity. There is currently no consensus on recommendations for overall management in pregnancies complicated by pulmonary arterial hypertension. We recommend institutions help build a multidisciplinary team with knowledge about pulmonary arterial hypertension to coordinate care during pregnancy, at delivery and in the postpartum period. The purpose of this article is to highlight some of the challenges in caring for these women, review the literature and help guide care teams by outlining our management process for 5 pregnant patients with WHO Group 1 pulmonary arterial hypertension on epoprostenol.

Asymptomatic Pulmonary Embolism after Ablation

Cardiology ◽  
2016 ◽  
Vol 134 (4) ◽  
pp. 426-432 ◽  
Author(s):  
Gamze Babur Guler ◽  
Mehmet Mustafa Can ◽  
Ekrem Guler ◽  
Tugba Akinci ◽  
Ozlem Sogukpinar ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Sudden Cardiac Arrest ◽  
Right Atrial ◽  
Arterial Tree ◽  
3 Dimensional ◽  
Life Threatening ◽  
History Of ◽  
Pulmonary Arterial ◽  
N 93 ◽  
Ischemic Attack

Background: Pulmonary embolism (PE) is a life-threatening event with a broad presentation spectrum ranging from asymptomatic cases to sudden cardiac arrest. It is unclear if right atrial emboli cause PE in patients with atrial fibrillation (AF) or if mild PE itself increases right cardiac pressure provoking AF. Objective: To determine the incidence and predictors of asymptomatic PE in patients undergoing AF ablation. Method and Results: Patients (n = 93) were screened and those with previous or current symptomatic PE or venous thromboembolism, pulmonary hypertension, increased right heart pressures detected on echocardiography, a history of stroke, transient ischemic attack, coagulopathy or cancer and inappropriate contrast for the evaluation of pulmonary arterial tree were excluded. The remaining AF patients (n = 71) underwent guided ablation controlled with 3-dimensional, left atrial and pulmonary venous computed tomography. The asymptomatic PE was defined by using the modified Miller score by 2 independent assessors in 6 patients. Univariate logistic regression showed that age (OR: 1.094, 95% CI 1.007-1.188, p = 0.033), diabetes (OR: 12.000, 95% CI 1.902-75.716, p = 0.008), CHA2DS2-VASc score (OR: 2.800, 95% CI 1.304-6.013, p = 0.008), and pulmonary artery diameter (OR: 1.221, 95% CI 1.033-1.444, p = 0.019) were significantly associated with PE. However, multivariate analysis revealed that the CHA2DS2-VASc score (p = 0.047) remained the exclusive significant predictor for asymptomatic PE. Conclusion: The incidence of random asymptomatic PE in AF patients is high (>8%). The CHA2DS2-VASc score can predict silent PE. Since patients with a high CHA2DS2-VASc score are already anticoagulated, our results do not change clinical practice but are noteworthy in terms of the cause-effect relationship between AF and PE.

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