Abstract

Girolamo Giro, Castro Vito and Gava Aldo

A 37 year old Asian pregnant woman referred to our outpatients facility at the 31st gestational week with a few days history of asthenia, dyspnea by walking and tachycardia in the early morning by waking up. The objective examination revealed elevated heart rate (80beats/min), arrhythmia and abnormal respiratory rate (20 breaths/min).The urgent haemogram showed hypochromic anaemia (Hb 10.0 g/dL), erithrocytopenia (3.79 x 106 /µL) and normal leukocytes (8.06 x 103 /µL) . The cardiology evaluation with echocardiography found severe atrial fibrillation, mitral stenosis and pulmonary hypertension associated with severe bi-atrial dilatation. In relation to the patient conditions, an intensive heart monitoring was started. The patient was treated for respiratory distress syndrome prophylaxis (Betametasone 12 mg i.m. x2) and Low Molecular Weight Heparin prophylaxis (Seleparine 6000 UI tid). Initially, there was a successful pharmacological cardioversion, but after some days atrial fibrillation reappeared (150 bpm). At the 33 gestational week, after a multidisciplinary discussion, cesarean section was performed. Five days after delivery the patient developed anaemia, fever, leukocytosis and C-reactive protein increase. Active treatment included haemotransfusion, wide spectrum antibiotics and dicumarolic prophylaxis, and forty days after delivery the patient was successfully discharged with good health conditions.