A case of rheumatic heart disease diagnosed in the third trimester

Amanda Manorot,Nina N Moreira

doi:10.17077/2154-4751.1459

Abstract

Migration from areas with a high incidence of rheumatic heart disease has led to an increase in pregnancy complicated by rheumatic heart disease in high-income countries. We present a case of rheumatic heart disease diagnosed in a 33-year-old G2P0010 French-speaking Congolese woman at 32 weeks gestation. She was initially hospitalized with respiratory syncytial virus (RSV) bronchiolitis at 24 weeks gestation and established care in our clinic. Mitral valve stenosis was identified at 32 weeks gestation after she presented with severe edema and was hospitalized for acute on chronic heart failure complicated by urosepsis and cellulitis. She was managed in the cardiovascular intensive care unit with a subsequent emergent cesarean delivery at 33 weeks gestation for nonreassuring fetal status. Postoperatively, pulmonary artery pressures were 40 mm Hg and left ventricular ejection fraction was 35%. Her condition stabilized and she was discharged home with outpatient cardiology management on postoperative day 10 with baby in the NICU. This case illustrates the importance of a high threshold of suspicion for women at risk for complications of heart disease in pregnancy. A triad of cardiovascular risk screening, patient education and multidisciplinary team planning with maternal-fetal medicine, cardiology, and anesthesiology has been shown to optimize outcomes in women with known cardiovascular disease.

Highlights

In the United States, 26.5% of pregnancy-related deaths are due to cardiovascular disease, making it the leading cause of death in pregnancy during the postpartum period.[1]
We present a case of rheumatic heart disease diagnosed in the third trimester of pregnancy at the University of Iowa Hospital and Clinics
The incidence of rheumatic fever in highincome countries has decreased substantially due to rapid diagnosis and treatment of streptococcal pharyngitis.[4]

Summary

Introduction

In the United States, 26.5% of pregnancy-related deaths are due to cardiovascular disease, making it the leading cause of death in pregnancy during the postpartum period.[1]. A 33-year-old G2P0010 Congolese woman at 24 weeks gestation with type 2 diabetes mellitus and uterine fibroids was transferred from her local intensive care unit 1.5 hours away to our medical intensive care unit for hypoxemic respiratory failure secondary to respiratory syncytial virus (RSV) bronchiolitis. She was managed by internal medicine with oral prednisone and bronchodilators and received antibiotics for a urinary tract infection. She required 2 units of blood for symptomatic anemia and was discharged in stable condition on postoperative day 10 She denied any knowledge of rheumatic fever as a child or history of heart disease. Her care was complicated by a French Lingala language barrier requiring phone interpretation services

Discussion

Findings

ACOG Practice Bulletin No 212