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CASE20191113_006
| OTHER - Women's Health Issues | |
| A Rare Case of Transient Complete Heart Block Post Partum in a 30-Year-Old Lady | |
| Dr.Swarnali Mani Joardar1, Siddhartha Mani2, Purushottam Kumar | |
| Sagar Dutta Medical College, India1, NH-Rabindranath Tagore International Institute of Cardiac Sciences, India2, | |
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[Clinical Information]
- Patient initials or identifier number:
IGT999
-Relevant clinical history and physical exam:
Thirty years old lady having a history of infertility having no signs of endometriosis on hysteroscopy having a drug history of Tablet Letrozole 2.5mg with a preterm baby of 1 months presented to our hospital with chief complaints of Palpitations and uneasiness. Palpitations were not related to exertion, no chest pain, no alarm clock pattern, no increased urination.Baseline ECG showed RBBB with Left axis Deviation with Intermittent Complete heart block with Ventricular escape rhythm of 40 to 45bpm
   -Relevant test results prior to catheterization:
Blood Biochemistry was normal with Hb of 12.6g/dl, TLC 6.5/mm3, Platelets141/mm3, Seum Sodium 142mEq/L, Serum potassium 4.2mEq/L,Serum Creatinine 0.86Echo revealed no abnormality with ejection fraction of 60%coronary Angiography revealed Non critical coronary Artery disease
- Relevant catheterization findings:
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[Interventional Management]
- Procedural step:
In view of Intermittent Heart Block with Ventricular Escape Rhythm of 40-45 Beats per minute urgent temporary pacemaker implantation was done as a life-saving procedure.Seventy-two after the procedure the patient developed normal sinus rhythm.Temporary pacemaker was removed after sinus rhythm.Opinion regarding need of permanent pacemaker was discussed in the heart team but was deferred in view of Normal sinus rhythm.Expert Rheumatologist opinion was taken and AntiRo/AntiLa antibody was negative.Infant born was preterm by 1 months and was examined by a team of paediatrician and no congenital abnormality was found. Baby was 1900 grams and Anti Ro/Anti La antibody of infant was normal.
   - Case Summary:
Finding of a high degree AV block is rare in Pregnancy. Incidence of CHB in pregnancy is estimated to be 1 in 15000 to 20000 patients. It is usually congenital and remains undiscovered until adulthood. Cardiac output depends on Heart Rate and Stroke Volume. In women with complete Heart Block, cardiac output solely depends on stroke volume. Concern regarding Haemodynamics may be the main reason for temporary pacing in asymptomatic individuals. Hereby we conclude the case with no requirement for permanent pacing in view of no structural abnormality and a healthy infant having no signs of CHB.There are cases of requirement of Permanent Pacemaker in mothers for life.
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