{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T21:55:31Z","timestamp":1775166931205,"version":"3.50.1"},"reference-count":15,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,4,12]]},"abstract":"<jats:p>A 36-year-old nulliparous woman developed pre-eclampsia at gestational week (GW) 28<jats:sup>\u20136\/7<\/jats:sup>. Cardiac status was checked regularly. Heart rate of 93 beats per minute (bpm) with left atrial diameter (LAD) of 35\u2009mm, left ventricular hypertrophy and inferior vena cava diameter (IVCD) of 8\u2009mm at GW 32<jats:sup>\u20130\/7<\/jats:sup>decreased to 48 bpm with an expanded IVCD to 25\u2009mm, dilated left atrium (LAD to 39\u2009mm), increased pulmonary arterial pressure, increased systemic vascular resistance (approximate 3000 \u2009dyn s\/cm<jats:sup>5<\/jats:sup>) and biphasic intrarenal venous flow pattern 3.5\u2009hours prior to childbirth at GW 32<jats:sup>\u20133\/7<\/jats:sup>. Epigastralgia, tachycardia (160 bpm) and marked hypertension (201\/111\u2009mm Hg) occurring 2\u2009hours 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.<\/jats:p>","DOI":"10.1136\/bcr-2016-217964","type":"journal-article","created":{"date-parts":[[2017,5,13]],"date-time":"2017-05-13T07:25:21Z","timestamp":1494660321000},"page":"bcr-2016-217964","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Maternal bradycardia occurring prior to onset of HELLP syndrome in a woman with pre-eclampsia"],"prefix":"10.1136","volume":"2017","author":[{"given":"Ami","family":"Hosokawa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Umazume","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiro","family":"Yamada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hisanori","family":"Minakami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,5,13]]},"reference":[{"key":"2025042706101611000_2017.may12_5.bcr-2016-217964.1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00966.2001"},{"key":"2025042706101611000_2017.may12_5.bcr-2016-217964.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199611143352002"},{"key":"2025042706101611000_2017.may12_5.bcr-2016-217964.3","doi-asserted-by":"publisher","DOI":"10.1002\/ana.22066"},{"key":"2025042706101611000_2017.may12_5.bcr-2016-217964.4","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-10-1214"},{"key":"2025042706101611000_2017.may12_5.bcr-2016-217964.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.03.047"},{"key":"2025042706101611000_2017.may12_5.bcr-2016-217964.6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2015\/317146","article-title":"Gestational weight gain and peripartum cardiomyopathy in a twin pregnancy","volume":"2015","author":"Matsumiya","year":"2015","journal-title":"Case Rep Obstet Gynecol"},{"key":"2025042706101611000_2017.may12_5.bcr-2016-217964.7","doi-asserted-by":"crossref","unstructured":"Umazume T , Yamada T , Yamada S , et al . 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