Paroxysmal bidirectional ventricular tachycardia with tachycardiomyopathy in a pregnant woman.
Palpitations in pregnancy are not an uncommon complaint. We present a case of palpitations in the third trimester related to bidirectional ventricular tachycardia with evidence, of left ventricular systolic dysfunction. The case was successfully managed with flecainide therapy and urgent elective caesarean section. The rhythm stabilised to sinus rhythm and left ventricular systolic function normalised. We discuss the possible underlying diagnosis of catecholaminergic polymorphic ventricular tachycardia with resultant tachycardiomyopathy. A literature review of bidirectional ventricular tachycardia is presented. This is the first reported case of bidirectional VT producing LV systolic dysfunction, which normalised following stabilisation of rhythm. The complex issues of management of this case in particular with regard to the pregnancy are discussed.
Walker
Nicola L
NL
Department of Cardiology, Glasgow Royal Infirmary, Glasgow, UK.
Cobbe
Stuart M
SM
McGavigan
Andrew D
AD
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D017298:Bisoprolol / Q000627:therapeutic use; D002585:Cesarean Section; D005260:Female; D005424:Flecainide / Q000627:therapeutic use*; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D011256:Pregnancy Outcome; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D005424:Flecainide; D017298:Bisoprolol