Cardio-Obstetrics Fundamentals for Fellows-Arrhythmia and Ischemia in Pregnancy

Video Transcription

Video Summary

Module Four of the series focused on the management of arrhythmias and ischemic heart disease in pregnancy, highlighting the complexity and high stakes of these conditions in maternal care. Experts discussed arrhythmias such as supraventricular tachycardias (e.g., AV nodal reentrant tachycardia), ventricular ectopy, and symptomatic bradycardia, emphasizing tailored management strategies based on the presence of structural heart disease and symptom severity. Acute treatments include vagal maneuvers, adenosine, beta blockers, calcium channel blockers, and, if unstable, synchronized cardioversion; catheter ablation is generally reserved for postpartum. Ventricular arrhythmias, common but often benign during pregnancy, require ruling out structural heart disease and close monitoring; high-risk features demand inpatient care and possibly antiarrhythmic drugs. Management of patients with pacemakers or defibrillators was also discussed, highlighting safety during delivery. The module then addressed pregnancy-associated myocardial infarction (MI), noting spontaneous coronary artery dissection as the leading cause, particularly postpartum. Cardiac biomarkers like BNP and troponin maintain diagnostic utility in pregnancy. Radiation exposure concerns during coronary angiography were addressed, reassuring that diagnostic procedures remain safe when clinically indicated. Acute coronary syndrome management follows general principles with multidisciplinary care. Lastly, cardiac arrest in pregnancy, although rare, has poor prognosis. Modifications to ACLS include uterine displacement to improve cardiac output and resuscitative hysterotomy when indicated. Emphasis was placed on early recognition, use of maternal early warning signs, and post-arrest care including ECMO if necessary. Multidisciplinary collaboration and individualized patient-centered approaches are critical across all scenarios.

Keywords

arrhythmias in pregnancy

ischemic heart disease

supraventricular tachycardia

ventricular arrhythmias

pregnancy-associated myocardial infarction

spontaneous coronary artery dissection

cardiac arrest in pregnancy

multidisciplinary maternal cardiac care