Post-partum cardiogenic shock in a patient with permanent junctional re-entry tachycardia

Abstract

Permanent junctional reciprocating tachycardia (PJRT) is a rareform of supraventricular arrhythmia, most often encountered inchildrenandadolescents,characterizedbyantegradeconductionoverthe atrio-ventricular node and retrograde conduction over a decre-mental accessory pathway [1]. In the majority of the patients theclinical scenario is dominated by frequent episodes of palpitations,often triggered by exercise. In about 20–30% of cases PJRT maybecome incessant and lead to advanced left ventricular systolic dys-function, that is generally reversible after restoration of stable sinusrhythm [1–3]. However, cardiogenic shock caused by PJRT has neverbeen reported.We describe the case of a young woman with a history of PJRTdating from late childhood; a totally benign clinical scenario character-ized by periodic recurrences of well-tolerated arrhythmias rapidlyturnedintoadramaticadvancedheartfailuresettingsoonafterpartum.This case underlines the importance of an accurate evaluation andmanagement of cardiac arrhythmias during pregnancy.A young woman was chronically treated with atenolol (50 mg) tomanage recurrences of PJRT episodes. On treatment she suffered rareand self-limiting, mildly symptomatic episodes. At the age of 32 shebecame pregnant and beta-blocker therapy was withdrawn to avoidgrowth restriction to the fetus. A 12-lead ECG performed in the firstweeks of pregnancy showed normal sinus rhythm, and an echocar-