Maternal bradycardia occurring prior to onset of HELLP syndrome in a woman with pre-eclampsia

BMJ Case Reports
Ami HosokawaHisanori Minakami

Abstract

A 36-year-old nulliparous woman developed pre-eclampsia at gestational week (GW) 28-6/7 Cardiac status was checked regularly. Heart rate of 93 beats per minute (bpm) with left atrial diameter (LAD) of 35 mm, left ventricular hypertrophy and inferior vena cava diameter (IVCD) of 8 mm at GW 32-0/7 decreased to 48 bpm with an expanded IVCD to 25 mm, dilated left atrium (LAD to 39 mm), increased pulmonary arterial pressure, increased systemic vascular resistance (approximate 3000  dyn s/cm5) and biphasic intrarenal venous flow pattern 3.5 hours prior to childbirth at GW 32-3/7 Epigastralgia, tachycardia (160 bpm) and marked hypertension (201/111 mm Hg) occurring 2 hours after echocardiography necessitated caesarean section, with subsequent development of HELLP syndrome. Acute fluid shift from the splanchnic vasculature to central vasculature may have occurred causing HELLP syndrome as a result from vasospasm associated with sympathetic hyperactivity. The cause of bradycardia prior to tachycardia remains unclear.

References

Nov 14, 1996·The New England Journal of Medicine·H P SchobelR E Schmieder
Sep 18, 2002·American Journal of Physiology. Heart and Circulatory Physiology·Lisa A SimmonsRichmond W Jeremy
Jan 24, 2004·Anesthesiology·Simon Gelman, Phillip S Mushlin
Aug 10, 2010·Annals of Neurology·Iain PerkesDavid K Menon
Dec 14, 2011·Hypertension in Pregnancy : Official Journal of the International Society for the Study of Hypertension in Pregnancy·Takashi YamadaHisanori Minakami
Nov 22, 2014·BMJ Case Reports·Takeshi UmazumeHisanori Minakami
Jul 30, 2015·Case Reports in Obstetrics and Gynecology·Hiroko MatsumiyaSoromon Kataoka

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Citations

Sep 2, 2021·Naunyn-Schmiedeberg's Archives of Pharmacology·Yasser H HabibMahmoud M El-Mas

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