Ebstein’s Anomaly – A Rare Cause of Shortness of Breath in Pregnancy

CASE REPORT, January 2012, VOL II ISSUE I, ISSN 2042-4884
10.5083/ejcm.20424884.63 , Cite or Link Using DOI
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Azeem S. Sheikh, Caoimhe M. Lynch, Jeremy Brockelsby, Mark Belham, Deepa Gopalan

In October 2009, a 28-year-old woman, G1P0A0, presented at 24 weeks gestation, with a two week history of progressive shortness of breath. Prior to this admission, she had attended for routine antenatal care. She did not have any significant past medical history. On examination, she was not cyanosed. Her blood pressure was 80/40 mmHg, pulse was 100-120, irregularly, irregular and respiratory rate was 35 per minute. Her jugular venous pressure was raised to the ear lobes and she had mild peripheral oedema. Her chest was clear to auscultation. She had audible third and fourth heart sounds along with a 3/6 pansystolic murmur maximally heard in the third and fourth left intercostal spaces parasternally.

Her chest x-ray revealed severe cardiomegaly. Electrocardiogram showed atrial fibrillation  incomplete right bundle branch block with right ventricular strain pattern. A CT pulmonary angiogram showed no evidence of pulmonary embolism. Her transthoracic echocardiogram revealed normal left ventricle, dilated right ventricle with preserved contractility and severe tricuspid incompetence with a severely dilated right atrium. The findings were suggestive of a congenital Ebstein’s anomaly. She was admitted under the joint care of cardiology and obstetric medicine. She was treated with intravenous diuretics, digoxin and therapeutically  anticoagulated with subcutaneous Low-Molecular Weight (LMW) heparin. An obstetric ultrasound showed normal foetal anatomy and normal foetal growth.