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  #1  
Old 10-19-2011
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Default Cardiology

A 25-year-old woman comes to the emergency department complaining of increasing dyspnea and orthopnea over the past 10 days. She is in the thirty-second week of pregnancy and reports several episodes of paroxysmal nocturnal dyspnea for the last 4 nights. On arrival at the hospital she is given 60 mg of intravenous furosemide. However she does not improve upon diuresis. The family informs you that she has a history of rheumatic heart disease and rheumatic mitral stenosis. Her last echocardiogram revealed a mitral valve area of 1 cm2. Medications include digoxin 0.5 mg daily. On examination, her blood pressure is 95/85 mm Hg and pulse is 115/min. The jugular venous distention is at 15 cm of water. Lung examination reveals bilateral crackles. Her heart is irregular. Which of the following is the most appropriate management at this time?
A. Urgent direct-current cardioversion
B. Urgent induction of vaginal delivery
C. Urgent cesarean section
D. Percutaneous balloon valvotomy of the mitral valve
E. Treatment with lisinopril 10 mg
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Old 10-19-2011
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Originally Posted by drnrpatel View Post
A 25-year-old woman comes to the emergency department complaining of increasing dyspnea and orthopnea over the past 10 days. She is in the thirty-second week of pregnancy and reports several episodes of paroxysmal nocturnal dyspnea for the last 4 nights. On arrival at the hospital she is given 60 mg of intravenous furosemide. However she does not improve upon diuresis. The family informs you that she has a history of rheumatic heart disease and rheumatic mitral stenosis. Her last echocardiogram revealed a mitral valve area of 1 cm2. Medications include digoxin 0.5 mg daily. On examination, her blood pressure is 95/85 mm Hg and pulse is 115/min. The jugular venous distention is at 15 cm of water. Lung examination reveals bilateral crackles. Her heart is irregular. Which of the following is the most appropriate management at this time?
A. Urgent direct-current cardioversion
B. Urgent induction of vaginal delivery
C. Urgent cesarean section
D. Percutaneous balloon valvotomy of the mitral valve
E. Treatment with lisinopril 10 mg
D. Percutaneous balloon valvotomy of the mitral valve??
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  #3  
Old 10-19-2011
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D baloon valvuloplasty...
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Old 10-19-2011
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I'd go for A. Direct current cardioversion .
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Old 10-20-2011
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A??may b...cardioversion
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Old 10-20-2011
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its dddd...
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Old 10-20-2011
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Default Answer

The correct answer is D. This patient is in life-threatening pulmonary edema in the setting of critical mitral stenosis. Saving the life of the mother is of prime concern. If valvotomy is performed by an experienced operator, this procedure has a high rate of success and would relieve the stenosis immediately. It would correct the increase in the filling pressure. The fetus can be well protected with appropriate shielding from radiation.

If the patient becomes unstable with a further decrease in a blood pressure or increase in a heart rate, cardioversion (choice A), either electrical or chemical, may be required.

Induction of vaginal delivery (choice B) may place the mother and fetus at unnecessary risk at this time. Further, the patient may not have adequate time to go through this procedure.

Urgent cesarean section (choice C) would not correct the volume overload immediately and the volume imbalances may place the fetus at risk

Lisinopril, or any other ACE-inhibitor, is contraindicated in a pregnant woman, given the teratogenic nature of these medications (choice E).
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The above post was thanked by:
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