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

Hosokawa, Ami; Umazume, Takeshi; Yamada, Takahiro; Minakami, Hisanori

doi:10.1136/bcr-2016-217964

Cited by 8 publications

(10 citation statements)

References 15 publications

(10 reference statements)

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“…While looking for speci c clinical characteristics to this clinical rare entity we observed that women with delayed postpartum preeclampsia had a relative sinus bradycardia as one of the clinical signs at presentation. Similar observations were reported in few case reports in both ante partum and delayed post-partum preeclampsia [6,7,8]. Therefore, the present study aimed to validate these observations and to compare maternal heart rate in delayed postpartum preeclampsia to normotensive women on the same postpartum day.…”

Section: Introductionsupporting

confidence: 82%

Changes in maternal heart rate in delayed post-partum preeclampsia

Ravid

Ovadia

Asali

et al. 2022

Preprint

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Background To investigate the difference of maternal heart rate in women with delayed onset postpartum preeclampsia as compared to healthy controls. Methods The medical files of all women who were readmitted with delayed onset postpartum preeclampsia during 2014–2020 were reviewed. Data on maternal physiological characteristics were compared to healthy control group of women at the same post-partum day, with uncomplicated pregnancies. Results Included 45 women with the diagnosis of delayed onset of preeclampsia at 6.3 ± 2.86 post-partum day. As compared to controls (n = 49), women with delayed post-partum were older, 34.6 ± 5.4 vs. 32.3 ± 4.7 years, p = 0.003. There were no differences between groups regarding maternal gravidity, parity, BMI (kg/m2) or Hb level at delivery day. Women with delayed post-partum preeclampsia had lower mean pulse rate as compared to controls, 58 ± 15 bpm vs. 83 ± 11.6 bpm, respectively, P < 0.0001. Only 17% of the women in the delayed onset group had pulse rate above 70 bpm as compared to 83% in the control group. Conclusions Maternal low heart rate in cases with delayed onset of post-partum preeclampsia is an important clinical characteristic that may reflect baroreceptors response to maternal hypertension.

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Section: Introductionsupporting

confidence: 82%

Changes in maternal heart rate in delayed post-partum preeclampsia

Ravid

Ovadia

Asali

et al. 2022

Preprint

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“…This blood reservoir decreases with sympathetic activation, resulting in a rapid increase in venous return up to 800 mL. Preeclampsia is characterised by sympathetic overactivity,17 and ischaemia occurs in the splanchnic organs in severe forms of preeclampsia, such as the hemolysis, elevated liver enzymes and low platelet (HELLP) syndrome 22 23. Women with preeclampsia accounted for 67% (16/24) of women with HDP in this study (see footnote for table 1).…”

Section: Discussionmentioning

confidence: 66%

Association of peripartum troponin I levels with left ventricular relaxation in women with hypertensive disorders of pregnancy

Umazume

Yamada

et al. 2018

Open Heart

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ObjectiveWomen with hypertensive disorders of pregnancy (HDP) show elevated risk of heart failure despite decreased circulating plasma volume compared with those with normotensive control pregnancies (NCP). This study was performed to better characterise the heart in women with HDP and determine whether high-sensitivity troponin I (hs-TnI) around childbirth predicts reduced left ventricular (LV) relaxation at 1 month postpartum.MethodsEchocardiography was performed longitudinally during the first, second and third trimesters and immediately postpartum within 1 week and 1 month postpartum in 24 women with HDP, with simultaneous determination of blood variables in comparison with 51 women with NCP.ResultsCompared with NCP, HDP showed greater antepartum left atrial (LA) volume, LV mass and inferior vena cava (IVC) diameter, higher peripartum brain natriuretic peptide/N-terminal pro–B-type natriuretic peptide and hs-TnI with the highest value immediately postpartum, and lower early diastolic mitral annular velocity (e') during pregnancy/postpartum. In analyses of data on HDP and NCP, hs-TnI at the third trimester as well as that immediately postpartum was negatively correlated with later e' at 1 month postpartum. The areas under the receiver operating characteristic curves were 0.82 and 0.81 for hs-TnI at the third trimester and immediately postpartum, respectively, in the prediction of reduced LV relaxation at 1 month postpartum.ConclusionReduced LV diastolic function and decreased splanchnic blood reservoir may contribute to the increased third trimester IVC diameter and LA volume in women with HDP. The rise in hs-TnI around childbirth was associated with poor LV relaxation ability at 1 month postpartum.

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“…The mechanism of bradycardia in preeclampsia is unknown [ 4 , 5 ]. Our patient had normal electrolytes and no evidence of acute myocardial ischemia on electrocardiography and TTE.…”

Section: Discussionmentioning

confidence: 99%

“…Bradycardia, usually of modest-to-moderate severity given the clinical presentation, has been reported as a rare feature of preeclampsia; its mechanism, however, has generally been considered to be unknown [ 4 , 5 ]. The case reported here is illustrative of the potential for postpartum preeclampsia in an otherwise healthy young woman to present with a seemingly inappropriate relative bradycardia despite acute pulmonary edema.…”

Section: Introductionmentioning

confidence: 99%

Relative Sinus Bradycardia: An Unexpected Finding in Preeclampsia With Acute Pulmonary Edema

Angsubhakorn¹,

Benditt²

2021

Cureus

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Preeclampsia is a multifactorial pregnancy-specific syndrome, which can result in significant alterations in cardiovascular hemodynamics. We report an observation of unexpected relative bradycardia in a previously healthy woman who presented with postpartum preeclampsia and acute pulmonary edema. We observed an increase in heart rate following normalization of blood pressure, which suggested that the initial slower than expected heart rate may reflect a baroreceptor response to hypertension. Whether this finding should be regarded as a severe aspect of the disease spectrum needs further study.

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

Cited by 8 publications

References 15 publications

Changes in maternal heart rate in delayed post-partum preeclampsia

Changes in maternal heart rate in delayed post-partum preeclampsia

Association of peripartum troponin I levels with left ventricular relaxation in women with hypertensive disorders of pregnancy

Relative Sinus Bradycardia: An Unexpected Finding in Preeclampsia With Acute Pulmonary Edema

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