Case Presentation:
A 30‐year‐old woman, G7P4115, 14 weeks pregnant came to the ED complaining of heart racing, lightheadedness, and “feeling about to pass out”. Never had these symptoms before, including her multiple previous pregnancies. PMH was only pertinent for hypertension and gestational DM. Her cardiac physical examination was unremarkable, and her EKG presented only atrial premature complexes. Two hours into her ED visit, patient presented palpitations and the monitor showed an episode of non‐sustained ventricular tachycardia (NSVT). Admission was favored, and treatment was started on amiodarone first, and then transitioned to beta‐blockers. An Echocardiogram showed no abnormalities, as well as her laboratory values. Her symptoms continued and multiple NSVT episodes were seen. A loop recorder was placed to evaluate the frequency of her episodes and also if there were sustained VT. Throughout the pregnancy the patient presented increased amount of episodes, recorded by the loop recorder each day. Patient visited the ED for heart racing and near‐syncope many times. And the higher amount of VT was seen during the last month of her gestation, reaching 30+ episodes per day, from only 1‐2 per week in the beginning. Her beta‐blocker was increased up to 75mg twice daily, and that only controlled the episodes partially. It was the patient’s decision not to take other medications. Cesarean section was the delivery method and after that, her episodes decreased to 10+ for the first 10 days post‐op. The following month she had 2 episodes, and then only infrequent PVC’s. Her metoprolol was tapered down and eventually discontinued.
Discussion::
VT in pregnancy can be related to structural anomalies or be idiopathic. This case illustrates an idiopathic VT, described as monomorphic and without an apparent structural heart disease. There are different types, with the most frequent originating from the right ventricular outflow tract. The exact mechanism is unclear, but they could be linked to catecholamines. EKG, holter monitors, and loop recorders are used for diagnosis, with loop recorders providing a high yield if episodes are not frequent. Effective treatment is common with a cardioselective beta‐blocker during pregnancy. Some less common types respond well to verapamil. These medications should terminate acute episodes and also prevent recurrences. Idiopathic VT has a benign prognosis, usually not progressing to an unstable rhythm.
Conclusions:
Idiopathic VT is a rare, frightening, and limiting complication of pregnancy, requiring effective management, close follow‐up and good communication between provider and patient.