Obstetric Cardiac Arrest: A Case Report.

Cardiac arrest during pregnancy does not occur infrequently and is influenced by obstetric and non-obstetric factors. The patient described in this case report is a pregnant woman who suffered a leg injury that required urgent surgical repair. Moments prior to that procedure, the fetus experienced extreme bradycardia on fetal heart tone monitoring. An emergent cesarean section was performed, which was followed by the patient suffering cardiac arrest secondary to an acutely provoked pulmonary embolism. The patient underwent mechanical thrombectomy followed by EkoSonic endovascular system (EKOS) therapy, which was then complicated by a subcapsular hematoma. The patient ultimately had an inferior vena cava (IVC) filter placed, was started on oral anticoagulation, and eventually recovered with discharge to her home with her newborn infant. This report aims to discuss this critical case of obstetric cardiac arrest, detailing the emergent response, clinical management, challenges faced during resuscitation, and subsequent outcomes. Through this report, we seek to contribute to the growing body of knowledge on effectively managing cardiac emergencies in pregnancy, emphasizing interdisciplinary coordination and tailored interventions to enhance survival and recovery in this high-risk group.

A Case of Tachycardia-Induced Cardiomyopathy During Pregnancy: Clinical Presentation and Management.

A 28-year-old G2P0010 woman with a history of COVID infection during her current pregnancy treated with monoclonal antibodies and benign gestational thrombocytopenia presented for routine prenatal care at 33 weeks' gestation. The patient was asymptomatic, but incidental tachycardia was noted on the physical exam with an irregular rhythm. An electrocardiogram (ECG) was performed and was consistent with multifocal atrial tachycardia at a rate of 144 beats per minute. The patient was started on labetalol 50 mg daily and was referred to cardiology for consultation. An echocardiogram was performed and showed dilated left ventricular cavity with a moderately reduced ejection fraction of 40%. No previous echocardiogram was available for comparison; the patient had no history of cardiac disease. The dose of labetalol was increased to 50 mg twice daily and she was admitted for digoxin loading and titration. Though fetal tolerance was excellent, her heart rate was not controlled. Digoxin was switched to flecainide and labetalol was switched to metoprolol which improved her heart rate and repeat echocardiogram showed an ejection fraction of 50%. The patient was admitted for induction of labor at 39 weeks of gestation and continued intrapartum flecainide. Metoprolol was continued intra and postpartum. Flecainide was resumed at three days postpartum due to the recurrence of atrial tachycardia and has been maintained. A repeat echocardiogram is scheduled six weeks postpartum to evaluate left ventricular function and wean off antiarrhythmics.

Late Presentation of Acute Coronary Syndrome Complicated by Ventricular Septal Rupture.

Acquired ventricular septal rupture (VSR) is a rare but potentially fatal complication of late-presenting myocardial infarction (MI). In the era of revascularization and reperfusion therapy, the incidence of VSR has significantly decreased. Ruptures occur predominantly in patients with late-presenting ST elevation MI. Patients may present with a wide variety of symptoms ranging from chest pain and mild hemodynamic instability to profound cardiogenic shock. Inotropes, vasopressors, and mechanical support with intra-aortic balloon pumps and extracorporeal membrane oxygenation can be used to bridge patients to surgery. Despite treatment with ventricular septal repair, postsurgical mortality remains high. There is a wide variety of complications that can occur in the postoperative period. A multidisciplinary approach is vital in these patients who develop VSR. Improving awareness among healthcare professionals regarding the symptoms of acute coronary syndrome can hopefully help prevent delayed presentation of patients to healthcare facilities.

Fungal Endocarditis With Severe Vegetations of the Aortic Valve and Septic Emboli Secondary to Total Parenteral Nutrition.

Fungal endocarditis is a rare but serious complication of fungemia. It is most commonly caused by Candida species. Risk factors include prosthetic heart valves, injection drug use, and indwelling central venous catheters. In comparison to bacterial endocarditis, fungal endocarditis is more commonly associated with arterial embolization, likely due to the larger size of vegetations. Unfortunately, diagnosis is often delayed, contributing to significant morbidity and mortality. Relapses are common, and extended treatment is often warranted. Antifungal agents and valve replacement are the recommended treatments. However, in-hospital mortality remains at 36%. For these reasons, it is critical to have a high index of suspicion and not delay appropriate therapy.