Hidden Rhythms: A Complex Case of Hyperemesis Gravidarum-Induced Arrhythmias

Hyperemesis gravidarum (HG) is a severe condition marked by intense nausea and vomiting during pregnancy, which is different from typical morning sickness. It is marked by weight loss exceeding 5% of pre-pregnancy weight, ketonuria, dehydration, electrolyte imbalances, and in some cases, arrhythmias - primarily linked to electrolyte disturbances. Treatment typically involves conservative measures such as small, bland meals, medications like metoclopramide and ondansetron, and correction of electrolyte abnormalities. This case study presents a 29-year-old female, G5P2022, who arrived at the ED with severe nausea, vomiting, intermittent chest pain, and palpitations lasting five days. She was confirmed to be seven weeks and five days pregnant. Her medical history included preeclampsia with severe features and HG in prior pregnancies. Initial evaluations, including CBC, complete metabolic panel, and troponin levels, were unremarkable, with normal electrolytes. However, an ECG revealed multiple arrhythmias. Cardiology and electrophysiology consultations recommended outpatient follow-up. This case highlights the serious risks HG poses to both maternal and fetal health. Although arrhythmias are a recognized complication of HG, this case is notable for their occurrence despite normal electrolyte levels, emphasizing the complex interplay between HG and cardiac function.