BMJ Case Reports 2017; doi:10.1136/bcr-2016-217964
  • Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Maternal bradycardia occurring prior to onset of HELLP syndrome in a woman with pre-eclampsia

  1. Hisanori Minakami
  1. Graduate School of Medicine, Hokkaido University, Sapporo, Japan
  1. Correspondence to Dr Takeshi Umazume, takeuma{at}
  • Accepted 12 April 2017
  • Published 13 May 2017


A 36-year-old nulliparous woman developed pre-eclampsia at gestational week (GW) 28–6/7. Cardiac status was checked regularly. Heart rate of 93 beats per minute (bpm) with left atrial diameter (LAD) of 35 mm, left ventricular hypertrophy and inferior vena cava diameter (IVCD) of 8 mm at GW 32–0/7 decreased to 48 bpm with an expanded IVCD to 25 mm, dilated left atrium (LAD to 39 mm), increased pulmonary arterial pressure, increased systemic vascular resistance (approximate 3000  dyn s/cm5) and biphasic intrarenal venous flow pattern 3.5 hours prior to childbirth at GW 32–3/7. Epigastralgia, tachycardia (160 bpm) and marked hypertension (201/111 mm Hg) occurring 2 hours after echocardiography necessitated caesarean section, with subsequent development of HELLP syndrome. Acute fluid shift from the splanchnic vasculature to central vasculature may have occurred causing HELLP syndrome as a result from vasospasm associated with sympathetic hyperactivity. The cause of bradycardia prior to tachycardia remains unclear.


  • Contributors AH, TU, TY collected data from the patient and AH and HM drafted the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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