Example of regular follow-up and cardiology review
| Presentation A 40-year-old woman presented to the maternity assessment unit having become unwell 5 days following a recent cycle of chemotherapy. She described the clear onset of palpitations 4 hours earlier and denied this happening previously. She was 32 weeks pregnant and was diagnosed with breast cancer in pregnancy. A heart rate of 150 beats per minute (bpm) was identified on her initial observations. Her medications were low-molecular weight heparin (LMWH; prophylaxis); folic acid 5 mg and ondansetron 4 mg as needed. Her observations revealed a heart rate of 150 bpm, blood pressure of 110/62 mmHg, respiratory rate of 18 breaths per minute and oxygen saturations of 98% on room air. She was afebrile. 12-lead electrocardiography revealed atrial fibrillation with fast ventricular response and blood results were haemoglobin of 115 g/dL, potassium of 3.0 mmol/L and magnesium of 0.8 mmol/L. Recommended course of action She was admitted to the high-dependency unit where she could have cardiac monitoring. Electrolytes were replaced and she was given a trial of bisoprolol which did not provide sustained rate control. Echocardiography showed a structurally normal heart. Computed tomography pulmonary angiography showed no evidence of pulmonary embolism. After fasting for 6 hours, she was sedated and intubated in theatre for direct current cardioversion (DCCV). After successful restoration of sinus rhythm, she was started on a low-dose beta blocker and treatment dose LMWH and a careful plan regarding her delivery was made. Fetal monitoring was carried out before and after DCCV. Outcome Atrial fibrillation (AF) is uncommon in pregnant women. Underlying structural heart disease should be suspected and urgent echocardiography should be arranged. Women with paroxysmal AF need careful venous thromboembolism risk assessment and decisions made regarding either low- or high-dose LMWH. |