Pregnancy-related inappropriate sinus tachycardia: A cohort analysis of maternal and fetal outcomes

Background Little literature exists regarding the syndrome of inappropriate sinus tachycardia during pregnancy. We aimed to further understand the natural history of inappropriate sinus tachycardia in pregnancy, and to explore maternal and fetal outcomes. Methods A retrospective, observational cohort analysis of 19 pregnant women who presented with inappropriate sinus tachycardia. Results 42% attended the emergency department on more than 1 occasion with symptoms of inappropriate sinus tachycardia; 32% required hospital admission and 26% required pharmacological therapy. There were no maternal deaths, instances of heart failure or acute coronary syndrome, and no thromboembolic or haemorrhagic complications during pregnancy. Rates of caesarean section were similar to the background rate of our unit (32% and 27%, respectively). Rates of induction were notably elevated (58% vs 25%). Conclusion Inappropriate sinus tachycardia in pregnancy is associated with high rates of hospitalization and induction of labour, which may not be mandatory given the clinical findings in this group of women.

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Pregnancy related inappropriate sinus tachycardia: a distinct arrhythmia?

European Heart Journal ◽

10.1093/ehjci/ehaa946.3297 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Sharp ◽

C Patient ◽

J Pickett ◽

M Belham

Keyword(s):

Sinus Tachycardia ◽

Task Force ◽

Cohort Analysis ◽

Subsequent Pregnancy ◽

Autonomic Response ◽

Inappropriate Sinus Tachycardia ◽

Background Rate ◽

Persistent Symptoms ◽

Coronary Syndrome ◽

In Pregnancy

Abstract Background The syndrome of inappropriate sinus tachycardia (IST) is well recognized and affects ∼1% of the population. We believe IST in pregnancy is a relatively frequent yet under-recognized phenomenon that may represent a distinct arrhythmia. To date, there are only three case reports in the literature. Purpose To further understand the natural history of IST in pregnancy, and to explore maternal outcomes. Methods A retrospective, observational cohort analysis. Results 19 pregnant women presented to our institute with a definitive diagnosis of IST (as defined by task force criteria) between January 2016 and January 2017. Symptom onset was 4–36 weeks gestation (mean 20 weeks). Of those in their second or subsequent pregnancy (n=8), 50% described symptoms compatible with IST in previous pregnancies. 42% attended the emergency department on ≥1 occasion with symptoms of IST. 32% required hospital admission. 26% required pharmacological therapy (beta-blockers in all). There were no maternal deaths, instances of heart failure or acute coronary syndrome, no thromboembolic or haemorrhagic complications during pregnancy. Rates of Caesarean section were similar to the background rate of our unit; however, rates of induction were notably elevated (58% vs 25%), with 55% of these women being induced purely for symptoms of IST. Following delivery, symptoms resolved within one week for 17 of the women in the cohort, 1 had symptoms resolve after 4 month and 1 had persistent symptoms as she became pregnant again. Conclusion IST in pregnancy likely represents a distinct arrhythmia; the majority of individuals here had symptoms only during pregnancy, which resolved rapidly postpartum. Additionally, half of the women in a second or subsequent pregnancy had suffered IST symptoms during previous pregnancies, with no symptoms in between pregnancies. It is biologically plausible and may represent an exaggerated cardio-autonomic response to the physiological changes of pregnancy such as increased sympathetic tone and change in baroreceptor reflex sensitivity. Recognition of the condition is important given it is associated with significant morbidity, the distressing nature of symptoms leading to high rates of hospitalization and induction of labour. Funding Acknowledgement Type of funding source: None

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Fever in pregnancy and its maternal and fetal outcomes

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175273 ◽

2017 ◽

Vol 6 (12) ◽

pp. 5523

Author(s):

Vibha S. More

Keyword(s):

Tract Infection ◽

Cohort Analysis ◽

Tertiary Care ◽

Fetal Distress ◽

First Trimester ◽

Fetal Outcome ◽

Third Trimester ◽

Tertiary Care Centre ◽

Fetal Outcomes ◽

In Pregnancy

Background: Contemporary obstetrics has witnessed improved maternal and fetal outcomes, owing to several advances. Any source of maternal hyperthermia that results in significant core temperature increase (>38.9°C), could potentially affect the fetus. Hence a study was planned to know the effect of fever on maternal and fetal outcome.Methods: This was a retrospective cohort analysis of case-records, of patients admitted in the Department of Obstetrics and Gynecology at tertiary care centre, Mumbai, between May 2007 and October 2009. The main parameters of assessment included incidence of fever in pregnancy, causes of fever, effect of episode(s) of fever on maternal and fetal outcomes, effect of specific infection on maternal and fetal outcomes, impact of fever on antepartum, intrapartum and postpartum phasesResults: The incidence of fever was 10.5%. the common cause of fever was malaria (15%), urinary tract infection (14%), viral (14%), respiratory tract infection (18%), and typhoid (7%). Seventy eight percent had fever in third trimester. The most common antenatal complication observed was preterm (13%), premature rupture of membrane (12%), oligohydramnios (8%), intrauterine growth retardation (26%). The rate of LSCS was 13% in study group and the most common indication was fetal distress and meconium stained amniotic fluid.Conclusions: In the present study on fever during pregnancy and its maternal and fetal outcomes, fever was associated with a definite impact on maternal and fetal outcomes. Preterm and IUGR were the most common fetal complications. Duration of fever was linearly associated with poor outcomes. Different causes of fever also had different impact on maternal and fetal outcome. Preterm IUGR, MSAF were more common with malaria and tuberculosis. Abortion was more commonly seen in first trimester fever, whereas preterm, PROM in the third trimester fever. Hence it is suggested that fever during pregnancy needs to be promptly investigated and treated to have a better outcome.

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Inappropriate Sinus Tachycardia Following Viral Illness

Clinics and Practice ◽

10.3390/clinpract11020032 ◽

2021 ◽

Vol 11 (2) ◽

pp. 219-222

Author(s):

Khalid Sawalha ◽

Fuad Habash ◽

Srikanth Vallurupalli ◽

Hakan Paydak

Keyword(s):

Viral Infection ◽

Medical History ◽

Sinus Tachycardia ◽

Esophageal Disease ◽

Shortness Of Breath ◽

Past Medical History ◽

Inappropriate Sinus Tachycardia ◽

Laboratory Findings ◽

Viral Illness ◽

History Of

A 67-year-old female patient with a past medical history of menopause, migraines, and gastro-esophageal disease presented with palpitation, fatigue, and shortness of breath. One month prior to her presentation, she reported having flu-like symptoms. Her EKG showed sinus tachycardia with no other abnormality. Laboratory findings, along with imaging, showed normal results. The event monitor failed to detect any arrythmias. We report a case of inappropriate sinus tachycardia secondary to viral infection as a diagnosis of exclusion.

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Inappropriate sinus tachycardia in pregnancy: a benign phenomena?

BMJ Case Reports ◽

10.1136/bcr-2016-217026 ◽

2017 ◽

pp. bcr2016217026

Author(s):

Mark Belham ◽

Charlotte Patient ◽

Janet Pickett

Keyword(s):

Sinus Tachycardia ◽

Inappropriate Sinus Tachycardia ◽

In Pregnancy

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Incidence of cardiac arrhythmias in patients with COVID-19 infection according to 24-hour electrocardiogram monitoring

Zaporozhye Medical Journal ◽

10.14739/2310-1210.2021.6.239243 ◽

2021 ◽

Vol 23 (6) ◽

pp. 759-765

Author(s):

V. O. Zbitnieva ◽

O. B. Voloshyna ◽

I. V. Balashova ◽

O. R. Dukova ◽

I. S. Lysyi

Keyword(s):

Cardiovascular Disease ◽

Cardiac Arrhythmias ◽

Sinus Tachycardia ◽

Ecg Monitoring ◽

Inappropriate Sinus Tachycardia ◽

Ventricular Extrasystoles ◽

Significant Difference ◽

History Of ◽

Clinically Significant ◽

Electrocardiogram Monitoring

Cardiac arrhythmias in patients with COVID-19 infection may be due to many pathophysiological factors. Further study on the structure of arrhythmias in this category of patients will reveal clinically significant arrhythmias and select the optimal management. The aim: to determine the features of arrhythmias in patients with and without concomitant cardiovascular disease who suffered from COVID-19 infection based on the results of 24-hour electrocardiogram (ECG) monitoring. Materials and methods. 84 patients (45 men – 53.5 %, 39 women – 46.5 %) who had COVID-19 infection over 12 weeks previously were examined. Patients were divided into 2 groups – with and without a history of concomitant cardiovascular disease. The patient groups did not differ in age (P = 0.33) and sex (P = 0.58, P = 0.64). 24-hour ECG monitoring was performed on a Cardiosens K device (XAI-MEDICA, Kharkiv) according to the standard method. Results. Comparison of 12-channel ECG data did not reveal a significant difference in the incidence of single atrial (P = 0.13) and ventricular extrasystoles (P = 0.37) between the two groups, but sinus tachycardia was significantly more common in patients without concomitant cardiovascular disease (P = 0.022). According to 24-hour ECG monitoring, a significantly higher total number of arrhythmias, in particular, supraventricular extrasystoles (P = 0.009), high gradations of ventricular arrhythmias: paired ventricular extrasystoles (P = 0.041), ventricular bigeminy (P = 0.005), ventricular trigeminy (P = 0.004), ventricular salvos (P = 0.017) were detected significantly more frequently in patients with concomitant cardiovascular disease after COVID-19 infection than those in the comparison group. The results of 24-hour ECG monitoring also showed that patients without cardiovascular disease were significantly more likely to have inappropriate sinus tachycardia (P = 0.03) and postural orthostatic tachycardia (P = 0.04). Paroxysmal arrhythmias were significantly more common in patients with concomitant cardiovascular pathology, namely unstable (P = 0.002) and stable paroxysms of atrial tachycardia (P = 0.014), unstable paroxysms of monomorphic ventricular tachycardia (8.3 %), paroxysms of atrial fibrillation (6.2 %). Conclusions. 24-hour ECG monitoring should be advised in patients with COVID-19 infection and concomitant cardiovascular disease in addition to recording a standard 12-channel ECG to detect prognostically unfavorable cardiac arrhythmias, possible arrhythmogenic manifestations of post-COVID-19 syndrome and choose management tactics for these patients.

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A STUDY TO EVALUATE THE PREVALENCE AND CLINIC-ETIOLOGIC PROFILE OF THROMBOCYTOPENIA IN PREGNANCY: AN OBSERVATIONAL STUDY.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i7.1391 ◽

2020 ◽

Vol 4 (7) ◽

Author(s):

Sweety Rani ◽

Abha Rani Sinha

Keyword(s):

Observational Study ◽

Liver Disorder ◽

Clinical Findings ◽

Severe Thrombocytopenia ◽

Medical College ◽

High Risk Factors ◽

Gestational Thrombocytopenia ◽

History Of ◽

Keywords Pregnancy ◽

In Pregnancy

Objective: To evaluate the prevalence and clinic-etiologic profile of thrombocytopenia in pregnancy: Materials and Methods: The present hospital based observational study was conducted in the Department of Obstetrics and Gynecology, Patna Medical College and Hospital, Patna, Bihar from July 2016 to January 2017. A detailed obstetrics history was obtained and maternal high risk factors like preeclampsia, eclampsia, DIC, HELLP syndromes etc were noted. Medical history like anemia, malaria, dengue, liver disorder, current or previous bleeding problems, family history of bleeding & transfusion history were noted. Clinical findings suggestive of thrombocytopenia like petechiae, ecchymoses etc. were noted. Results: Out of total 74 patients, Gestational thrombocytopenia was the most common etiological factor with 41.9% cases followed by 35.1% for hypertensive disorders including HELLP syndrome followed by 6.8% for Malaria and dengue. The most common hemorrhagic presentation was petechiae, ecchymosis & purpura in 33.8% cases. Among the thrombocytopenic pregnant women in our study, 60.8% had mild thrombocytopenia, 24.3% had moderate thrombocytopenia and 14.9% had severe thrombocytopenia Conclusion: The study demonstrated that thrombocytopenia is a frequent finding in pregnancy. It has many potential causes but gestational thrombocytopenia (GT) predominates. Degree of thrombocytopenia was mild to moderate. Keywords: Pregnancy, Thrombocytopenia, Petechiae, Ecchymosis

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Clinical and Laboratory Improvement in Hyperadrenergic Postural Orthostatic Tachycardia Syndrome (POTS) after COVID-19 Infection

Case Reports in Cardiology ◽

10.1155/2021/7809231 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Rebecca A. Ocher ◽

Erika Padilla ◽

Jonathan C. Hsu ◽

Pam R. Taub

Keyword(s):

Heart Rate ◽

Sinus Tachycardia ◽

Symptomatic Improvement ◽

Postural Orthostatic Tachycardia Syndrome ◽

Av Block ◽

Event Monitoring ◽

Inappropriate Sinus Tachycardia ◽

History Of ◽

The Impact ◽

Catecholamine Levels

A 32-year-old woman with a history of symptomatic supraventricular tachycardia, inappropriate sinus tachycardia, and hyperadrenergic POTS was treated with ivabradine and metoprolol. She then presented with bradycardia and Mobitz II second-degree AV block on event monitoring six weeks after COVID-19 infection. Her post-viral workup revealed normalization of catecholamine levels and significant symptomatic improvement in heart rate. To the authors’ knowledge, this is the first reported case of improvement in POTS after COVID-19 infection. As our understanding of COVID-19 continues to improve, it will be vital to better understand the impact of COVID-19 dysautonomia on cardiac patients.

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Heart rate increase and inappropriate sinus tachycardia after cryoballoon pulmonary vein isolation for atrial fibrillation

Netherlands Heart Journal ◽

10.1007/s12471-021-01645-9 ◽

2021 ◽

Author(s):

C. van Deutekom ◽

B. A. Mulder ◽

H. F. Groenveld ◽

R. G. Tieleman ◽

A. C. P. Wiesfeld ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Sinus Tachycardia ◽

Rate Increase ◽

Holter Monitoring ◽

Entire Group ◽

Inappropriate Sinus Tachycardia ◽

History Of

Abstract Background Cryoballoon pulmonary vein isolation (PVI) is a common therapy for atrial fibrillation (AF). While moderately increased sinus rhythm heart rate (HR) after PVI has been observed, inappropriate sinus tachycardia (IST) is a rare phenomenon. We aimed to investigate the prevalence and natural history of an abnormal sinus HR response after cryoballoon PVI. Methods We included 169/646 (26.2%) patients with AF undergoing PVI with available Holter recordings before and 3, 6 and 12 months after the procedure. Patients with AF on Holter monitoring were excluded. Mean HR increase ≥ 20 bpm or an IST-like pattern (mean HR > 90 bpm or > 80 bpm when beta-blocking agents were used) following PVI was categorised as abnormal sinus HR response. Results Following PVI, mean HR ± standard deviation increased in the entire group from 63.5 ± 8.4 to 69.1 ± 9.9 bpm at 3 months (p < 0.001), and to 71.9 ± 9.4 bpm at 6 months (p < 0.001). At 12 months, mean HR was 71.2 ± 10.1 bpm (p < 0.001). Only 7/169 patients (4.1%) met criteria for abnormal sinus HR response: mean HR was 61.9 ± 10.6 bpm (pre-ablation), 84.6 ± 9.8 bpm (3 months), 80.1 ± 6.5 bpm (6 months) and 76.3 ± 10.1 bpm (12 months). Even at 12 months, mean HR was significantly different from that pre-ablation in this group (p = 0.033). However, in patients meeting IST-like pattern criteria, mean HR at 12 months was no longer significantly different from that pre-ablation. Conclusion Few patients had an abnormal sinus HR response after PVI. Peak HR was observed 3 months after PVI, but HR was still significantly increased 12 months post-ablation compared with pre-ablation. An IST-like pattern was rarely observed. In these patients, HR decreased to pre-ablation values within a year.

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LO63: Evaluation of epinephrine secondary effects in a Canadian emergency department anaphylaxis adult cohort

CJEM ◽

10.1017/cem.2020.118 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S30-S30

Author(s):

S. Gabrielli ◽

M. Ben-Shoshan ◽

A. Lachance ◽

M. Rhéaume ◽

L. Londei-Leduc ◽

...

Keyword(s):

Emergency Department ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Clinical Characteristics ◽

Sinus Tachycardia ◽

Secondary Effects ◽

Inappropriate Sinus Tachycardia ◽

Factors Associated ◽

History Of ◽

Reaction Severity

Introduction: There are few large-scale studies assessing the true risk of epinephrine use during anaphylaxis in adults. We aimed to assess the demographics, clinical characteristics, and secondary effects of epinephrine treatment and to determine factors associated with major and minor secondary effects associated with epinephrine use among adults with anaphylaxis. Methods: From May 2012 to February 2018, adults presenting to the Hôpital du Sacré-Coeur de Montréal (HSCM) emergency department (ED) with anaphylaxis were recruited prospectively as part of the Cross-Canada Anaphylaxis Registry (C-CARE). Missed cases were identified through a previously validated algorithm. Data were collected on demographics, clinical characteristics, and management of anaphylaxis using a structured chart review. Multivariate logistic regression models were compared to estimate factors associated with side effects of epinephrine administration. Results: Over a 6-year period, 402 adult patients presented to the ED at HSCM with anaphylaxis. The median age was 38 years (Interquartile Range [IQR]: 27, 52) and 40.4% were males. The main trigger for anaphylaxis was food (53.0%). A total of 286 patients (71.1%) received epinephrine treatment, of which 23.9% were treated in the pre-hospital setting, 47.0% received treatment in the ED, and 5.0% received epinephrine in both settings. Among patients treated with epinephrine, major secondary effects were rare (1.4% of patients), including new changes to electrocardiogram, arrhythmia, and neurological symptoms. Minor secondary effects due to epinephrine were reported in 50.0% of patients, mainly inappropriate sinus tachycardia (defined as a rate over 100 beats/minute in 30.1%). Major cardiovascular secondary effects were associated with regular use of beta-blockers (aOR 1.10 [95%CI, 1.02, 1.18]), regular use of ACE-inhibitors (aOR 1.16 [95%CI, 1.07, 1.27]), and receiving more than two doses of epinephrine (aOR 1.09 [95%CI, 1.00, 1.18]). The model was adjusted for age, history of ischemic heart disease, trigger of anaphylaxis, presence of asthma, sex, and reaction severity. Inappropriate sinus tachycardia was more likely in females (aOR 1.18 [95%CI, 1.04, 1.33]) and palpitations, tremors, and psychomotor agitation were more likely in females (aOR 1.09 [95%CI, 1.00, 1.19]) and among those receiving more than two doses of epinephrine (aOR 1.49 [95%CI, 1.14, 1.96]). The models were adjusted for age, regular use of medications, history of ischemic heart disease, triggers of anaphylaxis, presence of asthma, reaction severity, and IV administration of epinephrine. Conclusion: The low rate of occurrence of major secondary effects of epinephrine in the treatment of anaphylaxis in our study demonstrates the overall safety of epinephrine use.

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