Complete Heart Block In Pregnancy : A Case Report
Background: Complete heart block occurs due to various pathological conditions that cause an infiltration, fibrosis, or lose the connection from a part of the cardiac conduction system. Complete heart block in pregnancy is often caused by congenital anomalies. Around 30% cases, complete heart block remain asymptomatic and not detected until adulthood and may present in pregnancy state and puerperium. When the reversible cause of the AV Block cannot be found, the permanent pacemaker or temporary pacemaker may be indicated when the patients show the symptoms.
Case Illusration: A-21 year old female, G2P0A1 preterm pregnancy (27-28 weeks) with bradycardia. From electrocardiograph examination revealed Total AV Block with junctional escape rhytym. Transthoracic echocardiogram shows massive tricuspid regurgitation, early phase of peripartum cardiomyopathy and ejection fraction 36-40%. Caesarean section was peformed due to PPROM. A male baby was born with birth weight of 1100 grams, 32 centimeters of body length and APGAR score of 7/9. The baby was died in NICU on day care 4th, with suspected respiratory problem.
Conclusion: Complete heart block in pregnancy is a rare condition. This condition could remain asymptomatic and not detected until pregnancy. Multidisciplinary approach, close monitoring of the symptoms and cardiac functions are needed for patients with CHB.
2. Tietge W, Daniëls M. A case of an acquired high-degree AV block in a pregnant woman. Netherlands Hear J. 2008 Dec;16(12):419–21.
3. Agrawal A, Guzman DB, Budzikowski AS. Third-Degree Atrioventricular Block [Internet]. 2018. Available from: https://emedicine.medscape.com/article/162007-overview
4. Fiser W, Hayes K, Paydak H. Complete Heart block in Pregnancy. case reports Intern Med [Internet]. 2017;4:22–4. Available from: http://www.sciedu.ca/journal/index.php/crim/article/view/10719
5. Kumar AU, Sripriya R, Parthasarathy S, Ganesh BA, Ravishankar M. Congenital complete heart block and spinal anaesthesia for caesarean section. Indian J Anaesth [Internet]. 2012 Jan;56(1):72–4. Available from: https://pubmed.ncbi.nlm.nih.gov/22529426
6. Hidaka N, Chiba Y, Fukushima K, Wake N. Pregnant women with complete atrioventricular block: perinatal risks and review of management. Pacing Clin Electrophysiol. 2011 Sep;34(9):1161–76.
7. Bonanno C, Gaddipati S. Mechanisms of hemostasis at cesarean delivery. Clin Perinatol. 2008 Sep;35(3):531–47, xi.
8. Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy. Eur Heart J. 2011;32(24):3147–97.
9. Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007 Jan;28(2):230–68.
10. Elkayam U, Ostrzega E, Shotan A, Mehra A. Cardiovascular problems in pregnant women with the Marfan syndrome. Ann Intern Med. 1995 Jul;123(2):117–22.
11. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DEJ, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, . Circulation. 2010 Apr;121(13):e266-369.
12. Blake MJ, Martin A, Manktelow BN, Armstrong C, Halligan AW, Panerai RB, et al. Changes in baroreceptor sensitivity for heart rate during normotensive pregnancy and the puerperium. Clin Sci (Lond). 2000 Mar;98(3):259–68.
13. Sundararaman L, Hochman Cohn J, Ranasinghe JS. Complete heart block in pregnancy: case report, analysis, and review of anesthetic management. J Clin Anesth. 2016 Sep;33:58–61.
14. Mohapatra V, Panda A, Behera S, Behera JC. Complete Heart Block in Pregnancy: A Report of Emergency Caesarean Section in a Parturient without Pacemaker. J Clin Diagn Res. 2016 Oct;10(10):QD01–2.
15. Thorne S, MacGregor A, Nelson-Piercy C. Risks of contraception and pregnancy in heart disease. Heart 2006;92:1520–1525.
16. Coolen J, Turnelp R, Vonder Muhll I, Chandra S. Permanent pacemakers in pregnancy. Clin Exp Obstet Gynecol. 2011;38(3):297–8.
PDF downloads: 176
Copyright (c) 2021 Indonesian Journal of Cardiology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).