Non-sustained ventricular tachycardia (NSVT) presents significant challenges during pregnancy, particularly in patients with underlying conditions like β-thalassemia. We present a case of a 29-year-old pregnant woman with β-thalassemia minor who experienced NSVT at 27 weeks gestation. Despite initial concerns for structural heart disease, comprehensive evaluations were inconclusive. The management focused on medication selection and risk assessment to ensure maternal and fetal well-being. This case underscores the importance of a multidisciplinary approach involving cardiology, obstetrics, and hematology in managing NSVT during pregnancy, emphasizing risk stratification and collaborative decision-making for optimal outcomes.
Introduction
Non-sustained ventricular tachycardia (NSVT) is characterized by brief episodes of rapid ventricular rhythms, lasting less than 30 seconds. It can indicate underlying myocardial stress and is associated with conditions such as acute coronary syndromes, myocarditis, and electrolyte imbalances. NSVT warrants careful evaluation and management to prevent progression to sustained arrhythmias and potential complications like sudden cardiac death [1].
Case Presentation
A 29-year-old pregnant woman, gravida one para zero, at 27 weeks gestation, presented with palpitations, pre-syncope, and a sensation of a racing heart exacerbated by standing. She had a history of β-thalassemia minor and managed anemia with iron supplementation. Initial evaluation in the emergency department (ED) revealed sinus tachycardia and nonspecific ST segment depressions on EKG. While being monitored, she experienced a wide complex tachycardia, identified as NSVT, which spontaneously converted to normal sinus rhythm. Due to the concern for NSVT, she was transferred to a tertiary care center for further evaluation and management.
Inpatient evaluation included transthoracic echocardiogram (TTE) and stress testing, which showed no structural abnormalities or ischemia. She received treatment with metoprolol for arrhythmia control and electrolyte replacement to correct hypokalemia. Continuous monitoring with a Zoll Arrhythmia Management System was initiated, and after stabilizing, she was discharged with plans for close follow-up.
Discussion
β-Thalassemia minor, characterized by mild microcytic anemia, rarely predisposes to severe cardiac complications unless complicated by iron overload. In this case, NSVT was likely triggered by electrolyte imbalance and volume depletion rather than underlying cardiomyopathy. The challenge of managing NSVT during pregnancy involves balancing maternal treatment needs with fetal safety. Medication choices, such as beta-blockers, were selected cautiously to minimize potential risks to the fetus [2].
Patients with β-thalassemia are at increased risk for arrhythmias, although the incidence in β-thalassemia minor is lower compared to the major form. Long-term management focuses on monitoring and addressing complications like iron overload, which can affect cardiac function [3]. The decision to defer cardiac MRI due to fetal safety concerns highlights the complexities of diagnostic imaging during pregnancy.
Conclusion
This case underscores the complexities in managing NSVT in pregnant patients with underlying β-thalassemia minor. Collaborative efforts among cardiology, obstetrics, and hematology are essential for comprehensive care and risk stratification. Long-term follow-up is crucial to monitor maternal health and fetal development, ensuring optimal outcomes for both. Further research is needed to refine management strategies for arrhythmias in pregnant women with β-thalassemia minor, emphasizing safety and efficacy in this unique population.
