NEWSLETTER > JANUARY, 2011
Pregnancy with Heart Disease' an interesting case report by
Dr. Dibyendu Banerjee, DGO, MD, DNB
Consultant Gynaecologist
Dr. Dibyendu Banerjee, DGO, MD, DNB
Consultant Gynaecologist
Heart disease is a relatively common complication of pregnancy, with an incidence in the UK of about 1%. Heart disease is now second only to suicide as the leading cause of maternal mortality, with 44 deaths in 2000-2002. The increase in cardiac death rates since the mid-1980s (from about 5 to 20 deaths per million maternities) is due to acquired disease (up from 4 deaths in 19851987 to 27 in 2000-2002). This emphasizes the importance of careful evaluation of the cardiovascular system at first antenatal check in all pregnancies. Pregnancy is a challenge to women with heart disease because of the 50% increase in plasma volume and six-fold increase in the risk of thrombosis. Antenatal checks need to be frequent (weekly from 24 weeks), with careful assessment of heart rate and rhythm, with auscultation to detect the early sign of endocarditis or pulmonary oedema. If the mother has congenital heart disease, the incidence of congenital heart disease in the baby will be increased from the bac kground rate of 0.8% to 2.5%50%, depending on the nature of the mother's lesion. All these mothers should therefore be offered fetal cardiac scanning in the middle trimester. Delivery should be as low stress as possible, and the majority of women will be offered a trial of vaginal delivery with a low-dose slow incremental top-up epidural and elective instrumental delivery of the baby. Caesarean section poses an additional risk, and should be carried out only for specific obstetrical maternal indications.
Valvular heart disease is the second most frequent heart disease after congenital heart disease, during pregnancy in western countries and the most frequent in developing countries. Rheumatic heart disease is the main cause of valvular disease in young women and mitral stenosis is the most frequently encountered which is particularly important because it is the most poorly tolerated valvular disease during pregnancy.
Hemodynamic deterioration is directly related to increasing cardiac output and therefore most frequently develops during the second trimester.
The wide range of situations that may occur during pregnancy in women with rheumatic heart disease emphasizes the need for close cooperation between obstetrician and cardiologist at every step.
• Before pregnancy when preventive treatment of the valve disease is indicated, in particular in women with severe mitral stenosis.
• During pregnancy, particularly after the beginning of the second trimester, reacting promptly to any change in symptomatic status.
• At delivery, when the modality should be debated and planned in concert with the anesthetists and during the first day of the postpartum period.
Optimum management of pregnancy in women with heart disease is a team effort. , patients are best seen in joint antenatal cardiac clinics where their progress can be monitored and the delivery strategy planned.
Relatively high rates of fetal complication, in particular, fetal growth retardation, premature delivery and low birth weight, have been reported.
Valvular heart disease is the second most frequent heart disease after congenital heart disease, during pregnancy in western countries and the most frequent in developing countries. Rheumatic heart disease is the main cause of valvular disease in young women and mitral stenosis is the most frequently encountered which is particularly important because it is the most poorly tolerated valvular disease during pregnancy.
Hemodynamic deterioration is directly related to increasing cardiac output and therefore most frequently develops during the second trimester.
The wide range of situations that may occur during pregnancy in women with rheumatic heart disease emphasizes the need for close cooperation between obstetrician and cardiologist at every step.
• Before pregnancy when preventive treatment of the valve disease is indicated, in particular in women with severe mitral stenosis.
• During pregnancy, particularly after the beginning of the second trimester, reacting promptly to any change in symptomatic status.
• At delivery, when the modality should be debated and planned in concert with the anesthetists and during the first day of the postpartum period.
Optimum management of pregnancy in women with heart disease is a team effort. , patients are best seen in joint antenatal cardiac clinics where their progress can be monitored and the delivery strategy planned.
Relatively high rates of fetal complication, in particular, fetal growth retardation, premature delivery and low birth weight, have been reported.
Smt. Soma Bhattacharjee, 29 years old, primigravida, complained of sudden onset of breathlessness at around 34 weeks of Pregnancy. She was advised an echocardiography by her consultant Gynaecologist at Balurghat in West Dinajpur. She was diagnosed as a case of Congenital Heart Disease with Hypertension and was referred to SSKM Hospital, Kolkata.
Due to referral from a relative the patient came to consult me on 15th December, 2010 at Charnock Hospital. On Examination she had a BP of 160/90mmHg and did not complain of any specific discomfort. She was advised a repeat Echocardiography and USG for Fetal Profile. Fetal profile showed intra uterine growth retardation with mild oligohydramnios. She was put on Labetalol (100gm) twice daily and was advised admission on 21/12/10.
Her Echocardiography findings were:-
Impression
• Concentric left ventricular hypertrophy with moderate LV systolic dysfunction with LVEF 42%.
• Generalised wall hypokinesia.
• 29mm diameter Osteum secondum type of ASD seen with left to right shunt.
• Small patent ductus arteriiousus seen with left to right shunt.
• Moderate PAH with estimated PASP = 42mmHg.
• Chink of pericardial effusion seen.
• Dilated RA and RV seen.
• Moderate tricuspid and mitral regurgitation seen.
Dr. Debi Dutta was consulted and he gave his his consent for Caesarian Section with a high risk consent from the patient party. After detailed discussion with Dr. Dutta and Anaesthetists Dr. Santanu Biswas and Dr. Rajib Ghosh, Ceaserian Section was done on 22/12/2010 under epidural anesthesia.
The Ceaserian Section passed off uneventfully and special care was taken to prevent pre operative hypotension. Post operatively she was shifted to ICCU with Epidural Analgesia. On the second post operative day she was shifted to Maternity Ward.
The baby was a male and weight 2.4kg and had Apgar Score of 10 at 5min.The baby developed tachyopnoea after 6hrs, and was transferred to NICU AMRI Hospital, Saltlake. Echocardiography of the baby revealed mild ASD (Osteum Secondum Type).the baby recovered well.
The patient was discharged on the 9th day and left for her home as proud mother.
I sincerely thank all sections of the staff of this Hospital and my team for ensuring a non eventful management of such a complicated case of Pregnancy with Heart Disease.
The Ceaserian Section passed off uneventfully and special care was taken to prevent pre operative hypotension. Post operatively she was shifted to ICCU with Epidural Analgesia. On the second post operative day she was shifted to Maternity Ward.
The baby was a male and weight 2.4kg and had Apgar Score of 10 at 5min.The baby developed tachyopnoea after 6hrs, and was transferred to NICU AMRI Hospital, Saltlake. Echocardiography of the baby revealed mild ASD (Osteum Secondum Type).the baby recovered well.
The patient was discharged on the 9th day and left for her home as proud mother.
I sincerely thank all sections of the staff of this Hospital and my team for ensuring a non eventful management of such a complicated case of Pregnancy with Heart Disease.
Case Study by
Dr. D P Chakraborty (MD, Dip. Card)
Dr. D P Chakraborty (MD, Dip. Card)
Case Study by
Dr. Saibal Moitra, MD
Dr. Debi Dutta, MBBS
Dr. Saibal Moitra, MD
Dr. Debi Dutta, MBBS
45 years old lady, school teacher by profession, resident of Raipur, Chhattisgarh came with fever for last one and half month associated with cough with scanty mucoid expectoration. She was also complaining of joint pain. Initially her fever was high grade throughout the day and later it was mostly of low grade. Joint pain mostly involving the large joints like bilateral elbow joint, wrist joint knee and ankle joints etc. She has family history of tuberculosis as her brother and mother was suffering from tuberculosis.
Initially she was diagnosed as a case of enteric fever in Raipur and treated with co-amoxyclar and levofloxacin but fever was not subside and she was continuing with low grade fever but her joint pain increased.
She has no history of shortness of breath, no haemoptysis or rash or redness of eyes. No history of loss of conciousness, urinary and bowel symptoms or mouth ulcers. She is known diabetic and on oral hypoglycemic agents (Metformin & sulphonylurea).
On examination she was febrile initially countinuous low grade, no cyanosis, jaundice or odema. Haemodynamically she is stable no clubbing, cardiovascular examination was normal. Few crepstations on chest auscultation, CNS examination is normal. She has tenderness on bilateral elbow, wrist, knee and ankle joints and also metatarsophalangeal joints, Meta carpophalangeal joints with some, movement restriction. Shoulder, hip and all other small joints are not involved. sacro.i liac joint was sender but no spinal tendeness noted.
Differential diagnosis was made as, seronegative arthritis or sarcoidosis or tuberculosis.
When the lady was investigated, her blood sugar was uncontrolled, so she was shifted from OHA to subcutaneous insulin. Her Hb% was 10.8gm%. TLC and DLC is normal and ESR is raised. Renal parameters and liver function tests were normal.12 leasds ECG. No abnormality was detected. Her sputum for AFB (3 samples) were negative and gram stain & c/s-no bacterial growth seen. Malarial and typhoid antigen was negative. Anti-nuclear Antibody & RA factor was negative. Chest x-rays are normal. CECT Thorax done shows enlargement of multiple mediastinal Lymph nodes (Rt Lilar, paratracheal, Left Lilar and subcarinal group) the Lymp nodes showed:
• Ring enhancement
• Central hypodensity
• Trabeculations
These features are suggestive of Tubercular mediastinal Lymphadenopathy.
Serum Angiotensin-converting-enzyme (ACE) assay is normal.
Finally her provisional diagnosis is Poncet's Disease and she was started on ATD. After 1 month of ATD therapy there was no fever, joint pain had subsided and patient had gained weight, looked clinically better and tolerated the medicines well and on regular follow up.
She has no history of shortness of breath, no haemoptysis or rash or redness of eyes. No history of loss of conciousness, urinary and bowel symptoms or mouth ulcers. She is known diabetic and on oral hypoglycemic agents (Metformin & sulphonylurea).
On examination she was febrile initially countinuous low grade, no cyanosis, jaundice or odema. Haemodynamically she is stable no clubbing, cardiovascular examination was normal. Few crepstations on chest auscultation, CNS examination is normal. She has tenderness on bilateral elbow, wrist, knee and ankle joints and also metatarsophalangeal joints, Meta carpophalangeal joints with some, movement restriction. Shoulder, hip and all other small joints are not involved. sacro.i liac joint was sender but no spinal tendeness noted.
Differential diagnosis was made as, seronegative arthritis or sarcoidosis or tuberculosis.
When the lady was investigated, her blood sugar was uncontrolled, so she was shifted from OHA to subcutaneous insulin. Her Hb% was 10.8gm%. TLC and DLC is normal and ESR is raised. Renal parameters and liver function tests were normal.12 leasds ECG. No abnormality was detected. Her sputum for AFB (3 samples) were negative and gram stain & c/s-no bacterial growth seen. Malarial and typhoid antigen was negative. Anti-nuclear Antibody & RA factor was negative. Chest x-rays are normal. CECT Thorax done shows enlargement of multiple mediastinal Lymph nodes (Rt Lilar, paratracheal, Left Lilar and subcarinal group) the Lymp nodes showed:
• Ring enhancement
• Central hypodensity
• Trabeculations
These features are suggestive of Tubercular mediastinal Lymphadenopathy.
Serum Angiotensin-converting-enzyme (ACE) assay is normal.
Finally her provisional diagnosis is Poncet's Disease and she was started on ATD. After 1 month of ATD therapy there was no fever, joint pain had subsided and patient had gained weight, looked clinically better and tolerated the medicines well and on regular follow up.
Message From MD
Dear Patrons,
It is with a bit of a heavy heart that we at Charnock Hospital have to bid adieu to our beloved Dr Kaustubh Ray. He has been the MS of this hospital for the past few years and has proven to be a great asset to the hospital and a good friend. We wish him all the best in his next assignment and in life.
At the same time, with great pleasure, I welcome Dr Pinaki Bandyopadhyay to Charnock Hospital as our new Medical Superintendant. He chose to embrace Medical Administration as a profession and has equipped himself well in this regard. He has done his schooling from RK Mission, MBBS from NRS Medical College, PG Diploma in Medical Law and Ethics from NLSIU, MHA under WBUT and currently pursuing PG Diploma in Finance.
We hope to gain much from his exuberance and hope that under his leadership, Charnock Hospital will scale new heights. The way I see it, he is the right person in the right place …
Wishing both of them the very best in their careers.
Prashant Sharma.
Managing Director.
It is with a bit of a heavy heart that we at Charnock Hospital have to bid adieu to our beloved Dr Kaustubh Ray. He has been the MS of this hospital for the past few years and has proven to be a great asset to the hospital and a good friend. We wish him all the best in his next assignment and in life.
At the same time, with great pleasure, I welcome Dr Pinaki Bandyopadhyay to Charnock Hospital as our new Medical Superintendant. He chose to embrace Medical Administration as a profession and has equipped himself well in this regard. He has done his schooling from RK Mission, MBBS from NRS Medical College, PG Diploma in Medical Law and Ethics from NLSIU, MHA under WBUT and currently pursuing PG Diploma in Finance.
We hope to gain much from his exuberance and hope that under his leadership, Charnock Hospital will scale new heights. The way I see it, he is the right person in the right place …
Wishing both of them the very best in their careers.
Prashant Sharma.
Managing Director.
Message From MS
In The modern era of health care it is needed to implement scientific system of management to provide better service and to have good control system on vital events of life. Although terminology used seem to be theoretical but there is full practical implication if we observe sincerely. Question comes way you implement and way you control. In 1994 one article in leading news paper revealed that India as well as whole world needs good amount of doctors to come in health care management as well as persons who are working in health care system management should have good amount of knowledge regarding health care system.
Assessing the need I decided to shift to administration related to health care and became qualified as per basic requirements. But my belief is that not only single person change will not be worth. It is a team game and everyone has to participate and move accordingly. So information should disseminate from top to bottom and from bottom to top and everyone should participate in decision making situation, so to start a uniform team game.
Joining in Charnock Hospital & Research Centre Kolkata as Medical Superintendent is a recent experience. Reason is they think with priority of next level care to achieve besides profit making. Hospital is in the heart of city with all availability of resources in a well connected location. Some mechanical problem may present but we need to overcome it successfully with cooperation of all to take it to next level.
We need to have criticism which is constructive in nature rather than destructive.
Dr. Pinaki Bandyopadhyay
Assessing the need I decided to shift to administration related to health care and became qualified as per basic requirements. But my belief is that not only single person change will not be worth. It is a team game and everyone has to participate and move accordingly. So information should disseminate from top to bottom and from bottom to top and everyone should participate in decision making situation, so to start a uniform team game.
Joining in Charnock Hospital & Research Centre Kolkata as Medical Superintendent is a recent experience. Reason is they think with priority of next level care to achieve besides profit making. Hospital is in the heart of city with all availability of resources in a well connected location. Some mechanical problem may present but we need to overcome it successfully with cooperation of all to take it to next level.
We need to have criticism which is constructive in nature rather than destructive.
Dr. Pinaki Bandyopadhyay
Dr. Kaustubh Ray's Departing Speech
Dear all,
It has been three long years for me in Charnock Hospital, yet it passed so quickly that it seems I came here just a few days back. At this time I remember glimpses of those times when Charnock was passing through a real hard phase. Under the strict and visionary guidance of Mr. Susil Misra we sailed through and then we got our new and dynamic leader Mr. Prashant Sharma, who not only believes in leading from the front but also that everyone can be a leader. In the last two years Charnock has reached many a milestones that were possible due to dynamic leadership which was supported by the spirited teamwork of Team Charnock. Though I will not be there as the Medical Superintendent of Charnock Hospital anymore, I will always look forward to find Charnock's name in the front row of health care providers in Kolkata and West Bengal.
Finally I would like to request all of you to extend your hearty cooperation to Dr.Pinaki Banerjee, the new Medical Superintendent of Charnock Hospital, as you did to me.
It was a wonderful experience to be a member of Team Charnock. Good Luck!
It has been three long years for me in Charnock Hospital, yet it passed so quickly that it seems I came here just a few days back. At this time I remember glimpses of those times when Charnock was passing through a real hard phase. Under the strict and visionary guidance of Mr. Susil Misra we sailed through and then we got our new and dynamic leader Mr. Prashant Sharma, who not only believes in leading from the front but also that everyone can be a leader. In the last two years Charnock has reached many a milestones that were possible due to dynamic leadership which was supported by the spirited teamwork of Team Charnock. Though I will not be there as the Medical Superintendent of Charnock Hospital anymore, I will always look forward to find Charnock's name in the front row of health care providers in Kolkata and West Bengal.
Finally I would like to request all of you to extend your hearty cooperation to Dr.Pinaki Banerjee, the new Medical Superintendent of Charnock Hospital, as you did to me.
It was a wonderful experience to be a member of Team Charnock. Good Luck!
Departing Speech Of Our Staff Nurse
The desire for a compassionate touch is at its peak when one is confined to a Hospital Bed… I am ecstatic that I got this Goden opportunity to be an agent of compassion and love at Charnock Hospital, Kolkata for a period of 16 months. A wagonload of thanks to the management and staff of this esteemed institution for gifting me this enviable opportunity…..
Thank you… Thank u so much!
Bincy Augustine (The Recipiant Of The First Best Employee Award)
Thank you… Thank u so much!
Bincy Augustine (The Recipiant Of The First Best Employee Award)
Camp @ FCI
Recently, Charnock Hospital has been empanelled with Food Corporation of India (FCI) for treatment of their beneficiaries. As an awareness campaign, we had arranged for several Free Health Camps for FCI people.
The first Camp was held on the 8th of November, 2010 at Ashoknagar. ECG, Sugar(R), Blood Pressure testing and Doctor's consultation were being organized for. Around 75 employees were there to avail these facility.
The next Camp was held at Brace Bridge on the 20th of this month. The response was enormous! We had to close down the show because of time restrictions. As a result, we could only serve near about 105 employees.
The most recent one was on the 30th November, 2010 held at their Cossipore depot. Near about 87 employees attended the Camp.
However, just to summarize, we are enjoying conducting successful Health Camps for the benefit of mass.
The first Camp was held on the 8th of November, 2010 at Ashoknagar. ECG, Sugar(R), Blood Pressure testing and Doctor's consultation were being organized for. Around 75 employees were there to avail these facility.
The next Camp was held at Brace Bridge on the 20th of this month. The response was enormous! We had to close down the show because of time restrictions. As a result, we could only serve near about 105 employees.
The most recent one was on the 30th November, 2010 held at their Cossipore depot. Near about 87 employees attended the Camp.
However, just to summarize, we are enjoying conducting successful Health Camps for the benefit of mass.
Charnock Picnic
Best Employee December
Mr. ABHIJIT SARKAR (PHARMACY ASST.)
Mr. ABHIJIT SARKAR (PHARMACY ASST.)
Floor Of The Month December
RECEPTION
RECEPTION
Best Employee of the year 2010
MR. BISHNU KUMAR PAL
MR. BISHNU KUMAR PAL