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2004-02-03-07 Bradycardia from premature atrial contractions © Hernandez www.thefetus.net/

Bradycardia from premature atrial contractions

Alberto Hernandez , MD

Guadalajara Jalisco MEXICO

This 23 year-old primigravida was seen for routine scan at 22 weeks of pregnancy. There is a clear bradycardia .A 4-chamber view was normal, as it was the rest of cardiac anatomy. M-Doppler shows a irregular cardiac rhythm. We asked a Neonatal cardiologist to reviewed this case and concluded that this was a supraventricular arrhythmia (atrial extrasystoly)  with incomplete compensatory pause supported by the absent exaggerated ventricular peaks (which rules out a ventricular arrhythmia). It is very common and frequently related to methylxantines. So the patient was told to avoid this substances found in soft-drinks (Coke), coffe, tea, chocolates, wine and soy sauce. She was rescanned 1 month later and the cardiac rhythm was completely normal.

Even though the final diagnosis relies on a neonatal electrocardiogram, Pulse-Wave Doppler may be the only available tool. You can see a short period of time elapsed between beats (approximately. every 8 beats) specially before atrial contraction. Anatomic anomaly should be ruled-out first. A short-axis view should be attempted.

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