Tachycardia in pregnancy: when to worry?

Coad, Felicity; Frise, Charlotte

doi:10.7861/clinmed.2021-0495

Cited by 11 publications

(10 citation statements)

References 11 publications

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“…Sinus tachycardia is generally considered a benign arrhythmia, subsequently management recommendations are absent from newly published guidelines [17]. Therefore, the question remains: if persistent sinus tachycardia is considered a benign occurrence, with the only intervention to the patient being reassurance [18], why do women with persistent ST of unclear etiology experience higher rates of c-sections Answering this question may be of vital significance as it may shorten then LOS but also prevent unnecessary C-sections which can be associated with short-and long-term effects for both mother and child [19].…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of unexplained persistent sinus tachycardia in women with structurally normal heart during the peripartum period

Varrias

Sharma

Hentz

et al. 2022

BMC Pregnancy Childbirth

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Background Persistent sinus tachycardia (ST) is frequently encountered during pregnancy and peripartum period and its etiology often remains elusive. We sought to examine the possible association between unexplained persistent ST and obstetric outcomes. Methods A case control study was conducted using chart review of women admitted in labor to one of 7 hospitals of Northwell Health between January 2015 to June 2021. After excluding women with structurally abnormal hearts, we identified patients with persistent ST during the peripartum period, defined as a heart rate of more than 100 bpm for more than 48 h. A control group was created by randomly subsampling those who did not meet the inclusion criteria for sinus tachycardia. Obstetric outcomes were measured as mother’s length of stay (LOS), pre-term labor (PTL), admission to the neonatal ICU (NICU), and whether she received cesarean-section (CS). Results Seventy-eight patients with persistent ST were identified, out of 141,769 women admitted for labor throughout the Northwell Health system. 23 patients with ST attributable to infection or hypovolemia from anemia requiring transfusion and 55 with unclear etiology were identified. After adjusting for age and parity, pregnant mothers with ST were 2.35 times more likely to have a CS than those without (95% CI: 1.46–3.81, p = 0.0005) and had 1.38 times the LOS (1.21- 1.56, p < 0.0001). Among mothers with ST, those with unexplained ST were 2.14 times more likely to have a CS (1.22–3.75, p = 0.008). Conclusion Among pregnant patients, patients with ST have higher rates of CS.This association is unclear, however potential mechanisms include catecholamine surge, indolent infection, hormonal fluctuations, and medications. More studies are needed to explore the mechanism of ST in pregnant woman to determine the clinical significance and appropriate management.

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Section: Discussionmentioning

confidence: 99%

Clinical significance of unexplained persistent sinus tachycardia in women with structurally normal heart during the peripartum period

Varrias

Sharma

Hentz

et al. 2022

BMC Pregnancy Childbirth

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“…Additionally, mean arterial pressure (MAP) <70 mmHg is abnormal per SOFA score, 69 but would be considered normal during the early phases of pregnancy among healthy pregnant women 72,73 . Tachycardia is often present due to the lower MAP and vasodilation found during pregnancy, 74 and maternal tachypnea due to high progesterone levels could mimic sepsis presentation, leading to a false diagnosis 75 . Thus, the Society of Obstetric Medicine Australian and New Zealand (SOMANZ) recommends the utilization of the obstetrically modified SOFA score (omqSOFA) when screening for sepsis during pregnancy 76 .…”

Section: Sepsismentioning

confidence: 99%

Caring for two in the ICU: Pharmacotherapy in the critically ill pregnant patient

et al. 2023

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Safe and thoughtful medication management of pregnant patients requiring intensive care unit (ICU) level of care is key to optimizing outcomes for both mother and fetus. Pregnancy induces physiologic alterations that closely mirror the changes expected in a critically ill patient. These changes can be predictable depending on the gestational age and trimester and will directly impact the pharmacokinetic profile of medications commonly used in the ICU; examples include decreased gastric emptying, increased blood and plasma volume, increased glomerular filtration, and increased cardiac output. When pregnant patients require ICU care, the resulting impact on drug absorption, distribution, metabolism, and elimination can be difficult to predict. In addition, there are many nuances of medication metabolism and interface with the placental barrier that should be considered when selecting pharmacotherapy for the pregnant patient. Critical care clinicians need to be aware of medication interactions with the placenta and weigh the risk versus benefit profile of medication use in this patient population. Obstetric critical care admissions have increased over the years, especially during the coronavirus waves. Therefore, understanding the interplay between pregnancy and critical illness to optimize pharmacotherapy selection is crucial to improving health outcomes of mother and fetus. This review highlights pharmacotherapy considerations in the pregnant ICU patient for the following topics: physiologic alterations, categorizing medication risk, supportive care, sepsis, cardiogenic shock, acute respiratory distress syndrome, and venous thromboembolism.

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“…Maternal tachycardia is difficult to define with no national consensus on the threshold [2 ▪ ]. In gestations of >18 weeks, more than 10% of women already have a heart rate of >100 beats/min [2 ▪ ].…”

Section: Haemodynamic Changes In Pregnancymentioning

confidence: 99%

“…An ECG is a crucial investigation that will help identify those with sinus tachycardia or a primary tachyarrhythmia such as atrial fibrillation (AF), supraventricular tachycardia (SVT) or ventricular tachycardia (VT). ECGs in pregnancy can be difficult to interpret; physiological changes include left axis deviation, inverted T waves in lead III, V1, V2 and V3 and transient ST/T wave changes, all of which may imitate structural heart diseases [2 ▪ ,3].…”

Section: Step 2: Basic (Most Patients)mentioning

confidence: 99%

“…Emergency management of tachyarrhythmias is the same as nonobstetric patient, with either pharmacological interventions or electrical cardioversion, and will depend on haemodynamic stability and presence of adverse features [2 ▪ ]. In the peripartum period, altered maternal pharmacodynamics and pharmacokinetics could account for different drug doses being effective such as higher doses of digoxin required due to increased clearance and volume of distribution [4 ▪ ].…”

Section: Step 2: Basic (Most Patients)mentioning

confidence: 99%

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Postpartum maternal tachycardia – diagnostic pitfalls!

Mathur,

Tohani,

Patil

et al. 2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Maternal tachycardia is a common sign with a multitude of causes. We attempt to look at the most common sinister ones in the postpartum period. Recent findings Current guidelines differ in the definition of maternal tachycardia. It has been associated with adverse outcomes such as increased length of stay as well as higher mortality if there is underlying peripartum cardiomyopathy. Some recent studies look at common investigations and how these apply to peripartum women, such as ECG markers of arrhythmogenesis, reference ranges for PCT and echocardiogram findings during pregnancy prior to diagnosis of peripartum cardiomyopathy. Summary Physiological changes make it difficult to interpret maternal tachycardia and thus how best to manage it. We propose the idea of a three-step approach for the assessment of patients, aiming to identify causes including tachyarrhythmias, obstetric haemorrhage, sepsis, venous thromboembolism and peripartum cardiomyopathy. The first step ‘BEDSIDE’ applies to all patients looking at observations, history and examination. The second step ‘BASIC’, applies to most patients and covers ECG and basic blood tests. The final step ‘EXTRA’ assesses the need for further investigations including additional blood tests and imaging. By using this model, clinicians and healthcare professionals should be able to rationalise the need for more invasive investigations whilst maintain good high-quality care.

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Tachycardia in pregnancy: when to worry?

Cited by 11 publications

References 11 publications

Clinical significance of unexplained persistent sinus tachycardia in women with structurally normal heart during the peripartum period

Clinical significance of unexplained persistent sinus tachycardia in women with structurally normal heart during the peripartum period

Caring for two in the ICU: Pharmacotherapy in the critically ill pregnant patient

Postpartum maternal tachycardia – diagnostic pitfalls!

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