title: Therapeutic challenges and management of heart failure during pregnancy (part I).
abstract: Therapeutic management in pregnant patients with heart failure still remains a challenge, even though in most pregnant women with cardiac diseases an outcome is good. A 32-year-old woman, 17 weeks pregnant, was admitted to hospital with heart failure (HF) NYHA class III/IV. Echocardiography revealed enlarged LV, LVEF 13%, significant mitral insufficiency and pulmonary hypertension. The patient wished to continue the pregnancy. In a life-threatening condition, metoprolol, enalapril, spironolactone (for 5 days), furosemide, and digitalis were administered. Enalapril was continued for 42 days. Then the patient was switched to a dihydralazine and isosorbide mononitrate regimen. The fetus was controlled ultrasonographically. In the 19th week of pregnancy, the patient's condition improved (NYHA class II, LVEF 23%). The patient experienced 2 more episodes of HF exacerbation. In the 26th week of pregnancy, in a primary prevention of sudden cardiac death and because of 2nd-degree AV block, an ICD was implanted. In the 32nd week of pregnancy a cesarean section was performed. A male infant was delivered. The patient made a good recovery and was discharged on the 7th postoperative day. The newborn was discharged after 4 weeks, in good general condition. At 1-year follow-up the patient presented NYHA class II.<br />
authors.affiliation: Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland. kryczka_ka@yahoo.com
authors.forename: Karolina
authors.initials: K
authors.lastname: Kryczka
authors.forename: Zofia
authors.initials: Z
authors.lastname: Dzielińska
authors.forename: Andrzej
authors.initials: A
authors.lastname: Przybylski
authors.forename: Julia
authors.initials: J
authors.lastname: Szczudlik
authors.forename: Joanna
authors.initials: J
authors.lastname: Dangel
authors.forename: Marek
authors.initials: M
authors.lastname: Konka
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Czajkowski
authors.forename: Jacek
authors.initials: J
authors.lastname: Różański
authors.forename: Zofia T
authors.initials: ZT
authors.lastname: Bilińska
authors.forename: Marcin
authors.initials: M
authors.lastname: Demkow
mesh_terms: D000328:Adult; D004070:Digitalis; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000008:administration & dosage / Q000627:therapeutic use; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008790:Metoprolol / Q000008:administration & dosage / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology / Q000628:therapy*; D013148:Spironolactone / Q000008:administration & dosage / Q000627:therapeutic use; D018615:Ultrasonography, Doppler, Color
chemical_list: D013148:Spironolactone; D004656:Enalapril; D005665:Furosemide; D008790:Metoprolol