Breathing for Two

A 29 year old pregnant woman with undifferentiated connective tissue disease presented at 26 weeks of gestation with progressive dyspnea, cough, and presyncope. Initial evaluation revealed respiratory syncytial virus (RSV) infection, but further workup identified severe pulmonary arterial hypertension (PAH) with right ventricular failure. Diagnostic findings included elevated right heart pressures on catheterization (mean pulmonary arterial pressure: 57 mm Hg) and echocardiographic evidence of right ventricular dysfunction. The patient was managed with prostacyclin analogues and phosphodiesterase-5 inhibitors, followed by planned cesarean delivery at 33 weeks. Postpartum, her symptoms and hemodynamics improved significantly. This case underscores the challenges of diagnosing PAH during pregnancy, where symptoms often overlap with physiologic changes, and highlights the importance of multidisciplinary care to optimize outcomes.

A 29 year old pregnant woman with undifferentiated connective tissue disease presented at 26 weeks of gestation with progressive dyspnea, cough, and presyncope. Initial evaluation revealed respiratory syncytial virus (RSV) infection, but further workup identified severe pulmonary arterial hypertension (PAH) with right ventricular failure. Diagnostic findings included elevated right heart pressures on catheterization (mean pulmonary arterial pressure: 57 mm Hg) and echocardiographic evidence of right ventricular dysfunction. The patient was managed with prostacyclin analogues and phosphodiesterase-5 inhibitors, followed by planned cesarean delivery at 33 weeks. Postpartum, her symptoms and hemodynamics improved significantly. This case underscores the challenges of diagnosing PAH during pregnancy, where symptoms often overlap with physiologic changes, and highlights the importance of multidisciplinary care to optimize outcomes.