Pregnancy outcome in a case of non-obstructive hypertrophic cardiomyopathy
Habib, A.; Haque, T.
Mymensingh Medical Journal Mmj 22(3): 603-608
2013
ISSN/ISBN: 1022-4742 PMID: 23982559 Document Number: 670768
Hypertrophic cardiomyopathy (HCM) is a relatively common genetic disorder (1:500) inherited as an autosomal dominant trait. It is caused by mutations in any one of 10 genes encoding protein components of cardiac sarcomere. Some theoretically calculated risks exist when patients with HCM become pregnant. The physiologic increase of cardiac output and increased stroke volume may be impaired due to the non-compliant ventricular walls. In the first trimester, the physiologic hypervolemia of pregnancy to some extent counteracts the natural decrease in peripheral vascular resistance which would have otherwise provoked an obstruction gradientin systolic flow. As pregnancy advances, the vena caval compression may decrease venous return causing cardiac compromise, whereas the stress of labour may precipitate arrhythmia. We report our experience of a pregnancy with co-existant non-obstructive hypertrophic cardiomyopathy and nodal bradycardia ultimately resulting in pre-term delivery, neonatal death and maternal death in puerperium from overt cardiac failure after a relatively uneventful gestation.