Indian Journal of Emergency Medicine

A 20 years old female came to ED with c/o giddiness since 4 days, headache since 3 days with diplopia with slurring of speech, lower limb weakness, difficulty in swallowing, and dropping of left eyelid since 1 day. Patient had no any pre-existing comorbidity and not on any regular medication. Last menstrual period was on 5 days back. On examination Patient was vitally and haemodynamically stable. Diplopia on right sided distant vision present. Venous blood gas samples showed Hyponatremia. On CNS examination the Glasgow coma scale was 15/15 with power in upper and lower limb 5/5 bilaterally. There was no neck stiffness. Gag reflex present.

Patient was taken immediately on symptomatic supportive treatment and admitted in Intensive care unit. Patient was planned for contrast enhanced MRI brain, lumbar puncture for CSF study, chest x-ray, ultrasound whole abdomen. Blood samples for complete haemogram and other relevant blood investigations with serum electrolytes sent for further study.

A 57 year old female came to emergency department with complaint ofpain and swelling over right foot and leg distally. On local examination there was multiple scar marks with redness and blisters formation. Patient was also giving complaint of discharge from the site since night yesterday. On further examination the patient was conscious and little drowsy but in arousable state. On further evaluation, the patient was hypotensive with tachycardia andtachypnoea. Patient was known case of Arthritis and Hypothyroidism. On further assessment attendants gave history of Leech therapy over right foot and leg distally since 20 days prior coming to emergency department. The leech therapy was started at an Ayurvedic hospital for detoxification from steroid. Patient was on steroids since long time for arthritis and she was told in ayurvedic hospital that leech therapy will detoxify her blood and remove excess steroids from her body. Patient was immediately taken on to symptomatic supportive treatment with intravenous antibiotics, intravenous fluids and ionotropic support. All relevant investigations sent from emergency department and patient was admitted in Intensive Care Unit for observation. Patient was discharged after 5 days in haemodynamically stable condition.

The physiological changes during pregnancy predispose female of new-onset or recurrent arrhythmia. Supraventricular arrhythmia is that the commonest sort of arrhythmia during pregnancy and, although often benign in nature. We describe a complex case of supraventricular arrhythmia during pregnancy and review the currently available literature. In pregnancies complicated by arrhythmia, a follow-up and both maternal and fetal monitoring during pregnancy, delivery and post partum should be made. Diagnostic modalities should be used as in non-pregnant women. All antiarrhythmic drugs cross the placenta, but when necessary, medical treatment should be used.

Electrical cardioversion is safe during pregnancy, and electrophysiological study and catheter ablation sometimes performed in selected patients, preferably with zero-fluoroscopy technique. Sometimes, delivering the fetus (if viable) is that the best therapeutic option.