Tachycardia Review Paper

I evaluated Jamie today for follow-up evaluation. Her pregnancy has been complicated by AMA, maternal hypothyroidism, maternal tachycardia, and borderline elevations of bile salts.

With respect to AMA, she had noninvasive prenatal testing (NIPT) earlier this pregnancy after genetic counseling and results were considered low-risk.

With respect to her tachycardia, she was evaluated by cardiology. She does have a long history of episodes of tachycardia that do not seem to have changed significantly with pregnancy. She has telemetry that demonstrates evidence of PAC’s and overall, she had mild sinus tachycardia with some episodes of moderate tachycardia with heart rate in the 120’s-130’s.

With respect to possible cholestasis of pregnancy, she has had fairly significant pruritus over the last 3-4 months. She initially had bile salts drawn on October 11th. These were drawn at Lisa Ross Birthing Center and evaluated at Spectrum lab. Measured bile salts were 2.9. She subsequently had follow-up in our office and we sent bile salts to LabCor on November 3rd and they were considered normal at 7.0 with a reference range of 3.7-14.5. She had labs again at Spectrum labs on December 14th and bile salts had increased further 14.0. While this was

We will plan to repeat bile salts at her next visit and we can discuss further management options. Typically, early delivery is recommended for cholestasis of pregnancy. Since she is multiparous and has had successful vaginal deliveries previously, she is likely a good candidate for IOL perhaps at 39 weeks. We will repeat bile salts and if they are elevated we may recommend slightly earlier delivery. She spoke with midwifery service at Lisa Ross Birthing Center and attempt at induction will likely be indicated. She has requested transfer to UT Medical Center for delivery