I am reading the 2020 MBBRACE report and think that many of us will benefit from bite sized learnings.
MBBRACE is the report of confidential inquiries into maternal deaths in UK. The lessons learnt are may help in reducing maternal mortality and morbidity.

The report can be found here- https://www.npeu.ox.ac.uk/mbrrace-uk

( Disclaimer- the blog posts are not to be used for medical advice)

Starting with Lessons on Cardiovascular Disease

1. Learning – Wheeze can be due to pulmonary oedema.
   Wheeze which does not respond to standard asthma management and exertional syncope? Orthopnoea and chest pain? Consider these as a red flag symptoms of cardiovascular disease.

A raised respiratory rate, chest pain, persistent tachycardia and orthopnoea are important signs and symptoms of cardiac disease- should always be fully investigated.

2. A persistent sinus tachycardia is a ‘red flag’ and should always be investigated, particularly when there is associated breathlessness.
If there are any of the following symptoms- Breathlessness when lying down, Unexplained cough, particularly when lying down or which produces frothy pink sputum, Paroxysmal nocturnal dyspnoea – being woken from sleep by severe breathlessness and coughing, which may produce pink frothy sputum and is improved by moving to an upright position, Palpitation- and if no other cause is found, take a cardiac specific history and SUSPECT HEART FAILURE.

Exertional syncope should always be investigated further as it suggests an inability to increase cardiac output.
3. Anxiety- A feeling of anxiety may be a manifestation of hypoxia and of heart disease, and should not be automatically be assumed to be related to mental health, especially if a previously successful intervention is unhelpful. A lady reported anxiety attacks after delivery- started on Propranolol, which did not help. On examination, she had tachycardia, hypoxia and basal crepitations – oral antibiotics prescribed for a chest infection.few days later she presented to the emergency department with vomiting, dehydration and three week history of shortness of breath- diagnosed as cardiac failure- even after escalation of treatment, she died a few week later.

Further lessons to follow in my future posts…

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