RECURRENT AND LIFE-THREATENING PERIPARTUM CARDIOMYOPATHY: DIAGNOSIS, DELIVERY CONSIDERATIONS AND MANAGEMENT

Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy that can present as acute life-threatening pulmonary oedema in late pregnancy or early puerperium, its diagnosis is mainly by exclusion of other causes. Morbidity is high due to the reduced physiological reserve in pregnancy. PPCM and severe pre-eclampsia can co-exist and their clinical presentation may overlap, making the diagnosis more difficult and often delayed, with potentially devastating consequences. Here, we would like to share our experience of such a case and present to the readers how we dealt with the challenge. As obstetricians we often do not resort to transthoracic echocardiography, which in our case prompted the diagnosis timely. Lateral thinking and a heightened suspicion does help. Proper diagnosis is extremely important not only for the immediate appropriate management but also for advising long-term lifestyle modifications to minimize risk and counselling for future pregnancy.

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Dyspnoea at Term in an Obese Mother

Case Reports in Obstetrics and Gynecology ◽

10.1155/2011/317376 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3

Author(s):

Vicky O'Dwyer ◽

Yvonne O'Brien ◽

Nadine Farah ◽

Michael J. Turner

Keyword(s):

Differential Diagnosis ◽

Heart Disease ◽

Obese Woman ◽

Peripartum Cardiomyopathy ◽

Morbidly Obese ◽

Shortness Of Breath ◽

Healthy Women ◽

Obese Mother ◽

Life Threatening ◽

In Pregnancy

Peripartum cardiomyopathy is a serious, potentially life-threatening heart disease of uncertain aetiology in previously healthy women. We report a morbidly obese woman who presented with peripartum shortness of breath. We discuss the differential diagnosis of dyspnoea in pregnancy and highlight the complexity of care of the morbidly obese woman.

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Article Commentary: Acute Heart Failure: Is it Peripartum Cardiomyopathy or Not?

Obstetric Medicine ◽

10.1258/om.2012.120042 ◽

2013 ◽

Vol 6 (1) ◽

pp. 42-44

Author(s):

Katrin Bachelier-Walenta ◽

Denise Hilfiker-Kleiner ◽

Karen Sliwa

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Peripartum Cardiomyopathy ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Life Threatening

Peripartum cardiomyopathy (PPCM) is a potentially life-threatening disease that occurs in women of childbearing age.

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Could it have been better? A patient with peripartum cardiomyopathy treated with conventional therapy

Vojnosanitetski pregled ◽

10.2298/vsp1206526i ◽

2012 ◽

Vol 69 (6) ◽

pp. 526-530

Author(s):

Branislava Ivanovic ◽

Marijana Tadic ◽

Ruzica Maksimovic ◽

Bojana Orbovic

Keyword(s):

Heart Failure ◽

Conventional Treatment ◽

Ace Inhibitor ◽

Ventricular Dysfunction ◽

Complete Recovery ◽

Left Ventricular ◽

Peripartum Cardiomyopathy ◽

Partial Recovery ◽

Threatening Condition ◽

Life Threatening

Introduction. Peripartum cardiomyopathy is a life threatening condition of unknown cause that occurs in previously healthy women. It is characterized by symptoms of heart failure due to left ventricular dysfunction that occurs in the last month of pregnancy or the first five months after delivery. Case report. We presented woman who underwent caesarean section due to preeclampsia. Two weeks after delivery first signs of heart failure appeared and only after six weeks following the onset of symptoms peripartal cardiomyopathy was recognized. A conventional treatment with diuretics, ACE inhibitor and beta blocker along with anticoagulant therapy was applied, which resulted in a complete recovery of the left ventricular function four months after. Conclusion. Timely detection and initiation of treatment are an important precondition for the complete or partial recovery.

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Can peripartum cardiomyopathy be caused by chemotherapy and radiation of breast cancer?

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2012-0071 ◽

2013 ◽

Vol 2 (1-2) ◽

Author(s):

Andreas Kyvernitakis ◽

Ioannis Kyvernitakis ◽

Alexander Yang ◽

Ute-Susann Albert ◽

Stephan Schmidt ◽

...

Keyword(s):

Primary Treatment ◽

Left Breast ◽

Left Ventricular ◽

Peripartum Cardiomyopathy ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Surgical Interventions ◽

Life Threatening ◽

Cardiac Intensive Care

AbstractTo report on a pregnant woman with peripartum cardiomyopathy 7 years after combination chemotherapy with doxorubicine and radiation of cancer of the left breast.A 35-year old primigravida who was treated 7 years earlier with cancer of the left breast (ympT1c, ypN0, cM0), according to a neoadjuvant study protocol (GeparTrio), was transferred to our unit due to HELLP syndome at 35+5 weeks. Symptoms of cardiopulmonary decompensation occurred shortly after cesarean delivery of a healthy newborn. The patient was admitted to cardiac intensive care and treated with oxygen, diuretics and ACE inhibitors. Maternal left ventricular ejection fraction recovered within a few weeks without any surgical interventions and remained stable within 1 year of follow-up.The association between radical primary treatment of the left breast and life-threatening cardiac disease could possibly be provoked by pregnancy.

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Could it be Quetiapine-induced Peripartum Cardiomyopathy?

Obstetric Medicine ◽

10.1258/om.2012.120035 ◽

2013 ◽

Vol 6 (1) ◽

pp. 35-37

Author(s):

Mandeep Kaler ◽

Rameen Shakur ◽

Hazel I Learner ◽

Andrew Deaner ◽

Richard J Howard

Keyword(s):

World Health Organization ◽

Interesting Case ◽

Peripartum Cardiomyopathy ◽

World Health ◽

The World ◽

Life Threatening ◽

Life Threatening Complication ◽

Health Organization

Peri-partum Cardiomyopathy (PPCM) is a rare and life threatening complication of pregnancy. There are only two cases registered with the World Health Organization of cases of cardiomyopathy in patients taking Quetiapine. Here we discuss an interesting case of potential Quetiapine induced cardiomyopathy.

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Peripartum cardiomyopathy: a rare complication in a teenage pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212680 ◽

2021 ◽

Vol 10 (7) ◽

pp. 2854

Author(s):

Uma Chourasia ◽

Jyoti Nath Modi

Keyword(s):

Multidisciplinary Team ◽

Teenage Pregnancy ◽

Rare Complication ◽

Clinical Findings ◽

Peripartum Cardiomyopathy ◽

Team Approach ◽

Successful Management ◽

Emergency Cesarean ◽

Life Threatening ◽

High Index Of Suspicion

The aim of this case report was to present a rare case of peripartum cardiomyopathy (PPCM) in an adolescent primigravida, and discuss its presentation and successful management. PPCM is a relatively rare yet life threatening cardiac complication of pregnancy. It often remains undiagnosed as its symptoms may simulate the physiological symptoms of pregnancy and peripartum period. An early diagnosis is crucial for improving survival. We herein report an unusual case of PPCM in an young and otherwise healthy primigravida. A 19-year-old primigravida presented at 33 weeks of gestation with, severe pre-eclampsia with dyspnea, cough and discomfort in the chest. Based on clinical findings and ECG, the echocardiography was done, and a definitive diagnosis of PPCM was made. The patient was managed for heart failure and preeclampsia by a multidisciplinary team. Emergency cesarean was done for obstetric indication and patient was managed conservatively in intensive care unit. Patient improved clinically and was discharged at day 10. Peripartum cardiomyopathy though typically associates with advanced maternal age can occur in very young women as well. A high index of suspicion for PPCM is recommended on a background of `severe preeclampsia with breathlessness. Timely echocardiography for diagnosis, and a multidisciplinary team approach are a key to successful management. Clinical significance of the study was to shed new light on the unusual presentation of PPCM and to contribute to the existing knowledge of PPCM.

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Preeclampsia Complicated with Peripartum Cardiomyopathy: A Case Report

Austin Journal of Obstetrics and Gynecology ◽

10.26420/austiniobstetgynecol.2021.1185 ◽

2021 ◽

Vol 8 (6) ◽

Author(s):

Yi Y ◽

Keyword(s):

Heart Failure ◽

Delayed Diagnosis ◽

Clinical Syndrome ◽

Peripartum Cardiomyopathy ◽

Diagnostic Features ◽

Heart Failure Treatment ◽

High Risk Factors ◽

Mother And Child ◽

Life Threatening

Peripartum cardiomyopathy is a life-threatening and rare clinical syndrome requiring emergent treatment. Preeclampsia is one of the high-risk factors of peripartum cardiomyopathy. Signs of peripartum cardiomyopathy are often confused by other forms of heart failure, and delayed diagnosis will bring fatal complications to the mother and child. In this article, we report a case of a 31-year-old woman who presented as preeclampsia complicated with acute heart failure initially. According to the results of laboratory and echocardiography, we confirmed the diagnosis of perinatal cardiomyopathy. Through timely termination of pregnancy and postoperative heart failure treatment, the woman recovered well. Obstetricians often feel uncertain about how to quickly identify and diagnose peripartum cardiomyopathy, especially when combined with preeclampsia. An in-depth understanding of the different definitions and diagnostic features of these two conditions, as well as accurate characterization of the echocardiography in preeclampsia and peripartum cardiomyopathy, allows clinicians to manage these conditions appropriately.

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Risk for life-threatening arrhythmia in newly diagnosed peripartum cardiomyopathy with low ejection fraction: a German multi-centre analysis

Clinical Research in Cardiology ◽

10.1007/s00392-017-1090-5 ◽

2017 ◽

Vol 106 (8) ◽

pp. 582-589 ◽

Cited By ~ 36

Author(s):

David Duncker ◽

Ralf Westenfeld ◽

Torsten Konrad ◽

Tobias Pfeffer ◽

Carlos A. Correia de Freitas ◽

...

Keyword(s):

Ejection Fraction ◽

Peripartum Cardiomyopathy ◽

Newly Diagnosed ◽

Life Threatening ◽

Low Ejection Fraction

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Peripartum Cardiomyopathy (PPCM): How to Diagnose and Deal with?

Heart Science Journal ◽

10.21776/ub.hsj.2021.002.01.08 ◽

2021 ◽

Vol 2 (1) ◽

pp. 46-49

Author(s):

Monika Sitio ◽

Cholid Tri Tjahjono ◽

Heny Martini ◽

Novi Kurnianingsih

Keyword(s):

Heart Failure ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Peripartum Cardiomyopathy ◽

Morbidity And Mortality ◽

Shortness Of Breath ◽

History Taking ◽

Aldosterone Antagonist ◽

Threatening Condition ◽

Life Threatening

Peripartum cardiomyopathy (PPCM) is a diagnosis of exclusion, where patients present with heart failure (HF) secondary to left ventricular (LV) systolic dysfunction without any other cause of HF identified in the last month of pregnancy or within first five months after delivery, abortion, or miscarriage. PPCM is a life-threatening condition which frequently under diagnosed and inadequately treated, whereas the morbidity and mortality rate ranges between 7% and 50%. Early diagnosis is important to decrease morbidity and mortality. Therefore, it is necessary to report the case related to this condition. A 34-year-old woman was referred to RSSA with worsening shortness of breath (SOB). She has given birth about 2.5 months prior to admission. History taking and supporting findings form this case were supported to diagnosis of PPCM. She was treated with diuretic, aldosterone antagonist, ACE-I, beta blocker, anticoagulant, and bromocriptine. The symptoms were improved in the following days. She was discharged with better condition and educated to comply with medication.

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