Hypotensive Pregnant Pt

[Neb.EMT]

Other than supine hypotensive syndrome does anybody have an idea of what may cause hypotension in an 18 week pregnant pt. Dehydration has pretty much been ruled out. No pertinant Hx. Pt c/o "lightheadedness" and slight nausea (no vomiting). B/P 90/58, HR 120, respirs 16, monitor shows sinus tach. S/S come in spells, aprox. 3-4 x daily. Pt. eats good, has had prenatal care, and is otherwise having an uncomplicated pregnancy. What might we be looking at for Dx and what Tx. At this point MD has had no success with Dx. Let me know what you think.

[Dustdevil]

Several types of heart disease -- not necessarily related to age -- are commonly responsible for hypotensive states. Mitral stenosis, prolapse, obstruction and regurgitation are not uncommon in young adults and can cause episodic hypotension. Same with IHSS. Closely related, there are aortic abnormalities which can also cause this. Auscultation can reveal a lot of clues, and an echocardiogram may be indicated.

There are neurological abnormalities which can create a loss of normal sympathetic mechanisms, causing episodic hypotension.

And of course, many endocrine and metabolic disorders could be the cause. Acute adrenocortical insufficiency can develop from almost any prolonged stressful state. I would certainly think that pregnancy qualifies as that. Pregnancy can also create sugar problems, resulting in hypotension.

[Ridryder 911]

You also have to remember the maternal circulation is devloping as well. With this you see sometimes a "shift" and hypotention and an increase in circulationg voulme.

Be safe,

Ridryder 911

[vs-eh?]

As Rid said, maternal physiology changes...While the patient is more tachy than would normally be seen, boarderline tachycardia is not uncommon in the 1/2 trimester, neither is absolute/relative hypotension.

Were these dizzy spells related to the pt lying down and getting up?

Is the pt generally a small/average/large woman?

Grav/Para?

Anxiety?

The things Dust mentioned?

[Ace844]

As Rid said, maternal physiology changes...While the patient is more tachy than would normally be seen, boarderline tachycardia is not uncommon in the 1/2 trimester, neither is absolute/relative hypotension.

Were these dizzy spells related to the pt lying down and getting up?

Is the pt generally a small/average/large woman?

Grav/Para?

Anxiety?

The things Dust mentioned?

Also, some of the variants of HELLP/Preeclampsia present this way initially. Also, wa sht epateitn screened for protinurea, etc.....???

out here,

ace844

[flight-lp]

Anemia perhaps???? Any hx. or iron deficiency?

[SingleLovingLife]

Gee, when this happened during my two pregnancies no one told me it was unusual! I was in my twenties, no significant health history, but a normally low blood pressure (110/70). The higher my heart rate got -- the lower my blood pressure went. Just got use to the dizzy spells that came with it. It never posed any other complications for me or my babies. Today both are teenagers -- and my blood pressure is SIGNIFICANTLY higher! LOL

[als_medic_uk]

The things I am thinking of are dehydration, prolonged bed rest, diabetes or maybe related to an anti-depressants was she taking any?

[1EMT-P]

It's hard to say without having addition information, I would be interested to see what her lab studies looked like... I would also be interested in seeing her EKG... Has she been ill recently? Has she had an Echo? What about a 24 hour cardiac event monitor?

[als_medic_uk]

It's hard to say without having addition information, I would be interested to see what her lab studies looked like... I would also be interested in seeing her EKG... Has she been ill recently? Has she had an Echo? What about a 24 hour cardiac event monitor?

Yes I would be interested in the 12-lead ECG, the 24 hour monitor perhaps is more of a long term cardiac diagnostic tool, not really for the EMS.