Alisha Menon
Northwell Health - Lenox Hill Hospital
New York, NY
Disclosure information not submitted.
Moses Bachan, MD, FACP, FCCP
MD
James J Peters Veterans Affairs Medical Center
Bronx, New York, United States
Disclosure information not submitted.
Zinobia Khan, MD, FACP, FCCP
Pulmonary and Critical Care Medicine Attending Physician
James J Peters Veterans Affairs Medical Center, United States
Disclosure information not submitted.
Niharika Kottapalli, MD
Resident Physician
Montefiore Medical Center- Wakefield, United States
Disclosure information not submitted.
Anu Menon, MD
Physician
Lenox Hill Hospital, New York, United States
Disclosure information not submitted.
Title: Matters of the Heart- A Case of Herpes Zoster induced SVT in Pregnancy
Case Report Body:
Introduction:
Materno-fetal transmitted diseases are routinely screened for during pregnancy. Most of these infections only cause mild maternal morbidity, but the consequences can be devastating for the fetus. This makes recognition of maternal illness and fetal monitoring imperative once the disease is confirmed. We present a case of Herpes Zoster (HZ) infection in pregnancy presenting with supraventricular tachycardia.
Description:
A 30-year-old woman, 35 weeks gestation, presented to the hospital with complaints of facial pain and rash present on the right side of her face, extending from the lip to ear for 6 days. The rash was initially papular but developed into painful vesicles, associated with dysphagia, and hearing disturbances. Patient denied chest pain, palpitations, or shortness of breath. The patient did not have any pre-existing medical comorbidities, past history was only significant for childhood chickenpox, and she had no family history of cardiac disease or arrhythmias. In the ED, the patient was noted to have a fever of 100.8 and her initial EKG revealed a narrow complex tachyarrhythmia, rate > 170 bpm. The patient was admitted to the OBGYN unit for further management of her pregnancy, complicated by HZ and SVT. The patient received 6 pushes of adenosine with no break in her SVT, ultimately requiring IV digoxin and progressive doses of metoprolol. An echocardiogram revealed an ejection fraction of 35% with regional wall abnormalities. The patient was empirically started on IV acyclovir, and the patient was transferred to the cardiac ICU for closer monitoring. After initiation of IV Acyclovir, the patient soon returned to normal sinus rhythm with no further need for beta-blockade. By the end of her hospitalization, her cardiac function recovered, with an ejection fraction of 60%.
Discussion:
Pregnancy, a state of altered immunity, makes a woman more susceptible to reactivation of HZ. It is generally diagnosed clinically by recognition of the classic zoster rash and can be confirmed with PCR. The known complications of HZ in pregnancy include post-herpetic neuralgia, zoster opthalmicus, disseminated HZ, meningoencephalitis, and superimposed bacterial infections. There are very few cases of HZ infection causing cardiomyopathy and arrhythmias in the pregnant population, such as in this case.