The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

PULMONARY HYPERTENSION AND NEW ONSET ASTHMA DURING PREGNANCY: A CASE REPORT

Betty L. Blake, Ghada Bourjeily; OB Medicine, Women and Infants Hospital, Providence, RI Betty L. Blake B.S., RRT, NPS, and Bourjeily, Ghada, MD. Women and Infants Hospital, Providence, Rhode Island

INTRODUCTION: Pulmonary hypertension (PH) is characterized by mean pulmonary artery pressure (PAP) >25mmHg at rest or >30mmHg with exercise. In a normal pregnancy, the increase in cardiac output (CO) and plasma volume are counterbalanced by a reduction in pulmonary vascular resistance, with no change in PAP. However, patients with PH are unable to compensate for that change in CO and PH significantly worsens in pregnancy. Therefore, women with this disease are strongly advised against pregnancy and many times pregnancy termination is needed. We describe a case of a pregnant patient with mild PH secondary to an acute bronchospastic episode. CASE STUDY: A 38 year old female Gravida 3 Para 2 at 27 weeks, without past medical history, was evaluated for dyspnea on exertion and then at rest. Exam was negative except for tachypnea and pregnancy body mass index of 37. Chest x-ray and perfusion scan were normal. 2D echocardiogram (ECHO) revealed PAP of 40 mmHg, an enlarged right ventricle (RV) with normal left ventricle. Spirometry suggested a restrictive physiology. The patient then developed worsening symptoms of dyspnea and wheezing on exam. She was treated with Levalbuterol, Ipratropium, oral and inhaled steroids along with long acting beta-agonists. Symptoms significantly improved with spirometry showing a significant increase in both FEV1 and FVC (33% and 40% from baseline respectively). ECHO showed normalization of RV size then of PAP. The patient remained on Advair 500/50 for the remainder of her pregnancy and had an uneventful labor, delivery and postpartum period. She had a healthy girl weighing 3900g. DISCUSSION: Close observation of this patient was necessary because of concern for PH manifesting in pregnancy and the high risk of mortality with the progressive increase in plasma volume and CO. In her case, PH was likely related to an exacerbation of newly diagnosed asthma. Once the patient‘s asthma was controlled, PAP dropped to the normal range. Pregnancy could have theoretically predisposed the patient to develop elevations in PAP with a relatively mild insult. Sponsored Research - None

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