Cardiac abnormalities in pulmonary oedema associated with hypertensive crises in pregnancy.
OBJECTIVE
To describe the cardiac abnormalities by two-dimensional and Doppler echocardiography (echo-Doppler) in hypertensive crises in pregnancy (HCP) complicated by pulmonary oedema and identify pathogenic factors.


METHODS
A prospective observational study.


METHODS
King Edward VIII Hospital, Durban, South Africa.


METHODS
Sixteen patients with HCP complicated by pulmonary oedema over a six-month period. Two control groups, 55 patients with HCP alone and 16 with normotensive pregnancies, were also studied.


RESULTS
Echocardiography diagnosed impaired left ventricular systolic function in 4 of 16 (25%) patients with HCP and pulmonary oedema. In the remaining 12 patients with preserved systolic function, left ventricular diastolic filling abnormalities were demonstrated in a significant proportion compared to control hypertensive and normotensive groups. Fifteen of 16 (94%) study patients presented with pulmonary oedema antepartum; in seven of these patients, the use of dexamethasone to enhance fetal lung maturity appeared to be a contributing factor in precipitating pulmonary oedema.


CONCLUSIONS
This study demonstrates the value of echo-Doppler to diagnose structural and functional cardiac abnormalities in HCP complicated by pulmonary oedema. The potential role of left ventricular diastolic filling abnormalities in the pathogenesis of pulmonary oedema complicating HCP is discussed.
Desai
D K
DK
MRC/UN Pregnancy Hypertension Research Unit, Faculty of Medicine, University of Natal, Durban, South Africa.
Moodley
J
J
Naidoo
D P
DP
Bhorat
I
I
D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000209:etiology; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D011225:Pre-Eclampsia / Q000150:complications; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000000981:diagnostic imaging* / Q000209:etiology; D016216:Ultrasonography, Prenatal; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*