scholarly journals Peripartum Cardiomyopathy: a Life Threatening Obstetric Emergency

2019 ◽  
Vol 13 (2) ◽  
pp. 93-96
Author(s):  
Dilruba Zeba ◽  
Mrinmoy Biswas ◽  
Rajib Biswas
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Angiotensin Receptor Blockers ◽  
Multiple Pregnancy ◽  
Systolic Heart Failure ◽  
Severe Heart Failure ◽  
Clinical Manifestations ◽  
Peripartum Cardiomyopathy ◽  
Presenting Symptoms ◽  
Life Threatening

Peripartum cardiomyopathy (PPCM) is a rare, life-threatening heart disease of unclear origin and is characterized by heart failure of sudden onset between the final weeks of pregnancy and 5 months after delivery. Incidence varies over geography and ethnicity. Risk factors include advanced maternal age, multiparity, preeclampsia, multiple pregnancy, anaemia, and so many other causes. PPCM is often not diagnosed until late in its course, because of its clinical manifestations are highly variable and a heart disease may not be suspected at first. Frequent presenting symptoms of PPCM, such as lassitude, shortness of breath on mild exertion and coughing are often initially misinterpreted as evidence of pneumonia or as physiological accompaniments of pregnancy and delivery. The clinical picture of PPCM corresponds to a dilated cardiomyopathy (DCM) with signs of severe heart failure. Medical management is similar to other causes of systolic heart failure, except for the ACE inhibitors and angiotensin receptor blockers are avoided in pregnancy. As there are lots of physiological changes during pregnancy and immediately after delivery, it is usually difficult to measure PPCM effectively. Complications include cardiac arrhythmia, thromboembolism, and refractory heart failure. Maternal deaths are not uncommon. Recently the role of abnormal prolactin metabolism and resulting myocardial toxicity have been explored and bromocriptine has shown promise as a potential treatment option. Faridpur Med. Coll. J. Jul 2018;13(2): 93-96

A case of peripartum cardiomyopathy associated with an atypical presentation of preeclampsia

2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Amit Verma ◽  
Shanthi Pinto
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Ventricular Dysfunction ◽  
Early Recognition ◽  
Good Prognosis ◽  
Peripartum Cardiomyopathy ◽  
Medical Professionals ◽  
Atypical Presentation ◽  
Life Threatening ◽  
High Index Of Suspicion

AbstractPeripartum cardiomyopathy is idiopathic heart failure occurring in the last month of pregnancy or during the first 5 months postpartum in the absence of determinable heart disease prior to the last month of pregnancy. We aim to raise awareness for this rare and potentially life-threatening disorder amongst all medical professionals involved in the care for pregnant women. A high index of suspicion is required for its diagnosis. Early recognition and treatment in a multidisciplinary team is vital for good prognosis, which depends on reversal of ventricular dysfunction.

scholarly journals Peripartum cardiomyopathy: an obstetric review

2017 ◽  
Vol 6 (2) ◽  
pp. 371 ◽  
Author(s):  
Priyanka Sharma ◽  
Binay Kumar
Keyword(s):  
Heart Failure ◽  
Post Partum ◽  
Angiotensin Receptor Blockers ◽  
Systolic Heart Failure ◽  
Viral Myocarditis ◽  
The United States ◽  
Peripartum Cardiomyopathy ◽  
Refractory Heart Failure ◽  
Receptor Blockers ◽  
Fatal Form

Peripartum cardiomyopathy (PPCM) is a rare and potentially fatal form of systolic heart failure which presents in later months of pregnancy and post-partum. Incidence varies over geography and ethnicity. It is highest in the African tribes of Hausa and Fulani. The incidence in the United States ranges from 1 in 1500-7500 births. Risk factors include advanced maternal age, multiparity, preeclampsia, multifetal gestation and African descent. Various etiologies such as viral myocarditis, abnormal immune and hemodynamic response to pregnancy, inflammatory mediation and genetic susceptibility have been proposed. Of late, the role of abnormal prolactin metabolism and resulting myocardial toxicity have been explored and bromocriptine has shown promise as a potential treatment option. Medical management is similar to other causes of systolic heart failure, except that ACE inhibitors and angiotensin receptor blockers are avoided in pregnancy. Complications include cardiac arrhythmias, thromboembolism and refractory heart failure can occur. Maternal deaths are not uncommon.

scholarly journals Dealing with Sudden Cardiac Death: Who Deserves Device Implantation

2019 ◽  
Vol 5 (1 (P)) ◽  
pp. 12
Author(s):  
Dicky Armein Hanafy
Keyword(s):  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Sudden Cardiac Death ◽  
Cardiac Arrhythmias ◽  
Cardiac Death ◽  
Cardiac Insufficiency ◽  
Resynchronization Therapy ◽  
Icd Implantation ◽  
Life Threatening

Sudden cardiac death is one of the leading causes of death in the western industrial nations. Most people are affected by coronary heart disease (coronary heart disease, CHD) or heart muscle (cardiomyopathy). These can lead to life-threatening cardiac arrhythmias. If the heartbeat is too slow due to impulse or conduction disturbances, cardiac pacemakers will be implanted. High-frequency and life-threatening arrhythmias of the ventricles (ventricular tachycardia, flutter or fibrillation) cannot be treated with a pacemaker. In such cases, an implantable cardioverter-defibrillator (ICD) is used, which additionally also provides all functions of a pacemaker. The implantation of a defibrillator is appropriate if a high risk of malignant arrhythmias has been established (primary prevention). If these life-threatening cardiac arrhythmias have occurred before and are not caused by a treatable (reversible) cause, ICD implantation will be used for secondary prevention. The device can stop these life-threatening cardiac arrhythmias by delivering a shock or rapid impulse delivery (antitachycardic pacing) to prevent sudden cardiac death. Another area of application for ICD therapy is advanced heart failure (heart failure), in which both main chambers and / or different wall sections of the left ventricle no longer work synchronously. This form of cardiac insufficiency can be treated by electrical stimulation (cardiac resynchronization therapy, CRT). Since the affected patients are also at increased risk for sudden cardiac death, combination devices are usually implanted, which combine heart failure treatment by resynchronization therapy and the prevention of sudden cardiac death by life-threatening arrhythmia of the heart chambers (CRT-D device). An ICD is implanted subcutaneously or under the pectoral muscle in the area of the left collarbone. Like pacemaker implantation, ICD implantation is a routine, low-complication procedure today.

scholarly journals Underlying causes of under-utilization of cardiac resynchronization therapy in real-world heart failure settings

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Choha ◽  
J Henrysson ◽  
E Thunstrom ◽  
M Fu ◽  
C Basic
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Cardiac Resynchronization Therapy ◽  
Real World ◽  
Angiotensin Receptor Blockers ◽  
Real Life ◽  
University Hospital ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Underlying Causes

Abstract Background Despite well-established effectiveness of cardiac resynchronization therapy (CRT) in patients with heart failure (HF), it remained significantly under-utilized. The underlying causes are still not well described. Aim To investigate how many patients with HF were eligible for CRT and determine underlying causes why CRT was abstained for these patients in real life settings. Methods Retrospective review of medical data was carried out in all patients hospitalized for newly diagnosed HF from January 1, 2016 to December 31, 2019. Patients were identified from the local university hospital register with three afiliations by use of international classification of disease (ICD)-10 codes I50.0-I50.9. Medical journals, including electrocardiograms and echocardiograms, were reviewed. The indication for CRT was evaluated three months after mineralocorticoid receptor antagonists (MRA) were initiated as addition to angiotensin converting enzyme inhibitor /angiotensin-receptor blockers and beta-blocker treatment according to European guidelines for heart failure from 2016. Follow-up was minimum one year and up to two years after HF diagnosis. Results In 3456 patients with HF, 642 (18.6%) were patients hospitalized for new onset of HF with ejection fraction (EF) <40%. Out of those, 104 (16.2%) patients were excluded because of incomplete medical record as a result of referral to primary care. Finally, 538 were included in this study. Overall, 163 patients (30.3%) met CRT criteria with 22.5%, 2.6%, 1.9% complying with recommendation IA, IIA, IIB respectively, and 3.9% had more than 50% right ventricular pacing. Only 52 (9.7%) of patients received CRT with mean age 69.3±11.5 years, and 69.2% men and EF 31.9% ± 7.6. In all these patients with HF eligible for CRT, no difference was found in baseline data including hypertension, ischemic heart disease, atrial fibrillation, valvular heart disease, diabetes mellitus, stroke, cancer and renal failure nor medical treatment between those received CRT and those without CRT. Among underlying causes of under-utilization of CRT, 24.3% were due to multiple concomitant comorbidities, 4.5% due to patient's own wish, 12.5% due to other reasons such as socioeconomic problems and 58.6% with unknown reasons. Mortality rates were 20.7% in patients without treatment with CRT compared with 7.7% in those who received CRT (p=0.037). Conclusion In this real world HF cohort, 1/3 patients were eligible for CRT treatment. However only 1/3 received CRT and 58.6% had no contraindication but did not receive CRT, which emphasize urgent need for structured implementation methods for device treatment in patients with HF. FUNDunding Acknowledgement Type of funding sources: None.

Secondary prevention of sudden cardiac death in ischaemic cardiomyopathy

ESC CardioMed ◽  
2018 ◽  
pp. 2337-2341
Author(s):  
Jens Cosedis Nielsen ◽  
Jens Kristensen
Keyword(s):  
Heart Failure ◽  
Cardiac Arrest ◽  
Heart Disease ◽  
High Risk ◽  
Sudden Cardiac Death ◽  
Secondary Prevention ◽  
Cardiac Death ◽  
Cardioverter Defibrillator ◽  
Ischaemic Cardiomyopathy ◽  
Life Threatening

The most common reason for sudden cardiac death is ischaemic heart disease. Patients who survive cardiac arrest are at particularly high risk of recurrent ventricular arrhythmia and sudden cardiac death, and are candidates for secondary prevention defined as ‘therapies to reduce the risk of sudden cardiac death in patients who have already experienced an aborted cardiac arrest or life-threatening arrhythmias’. The mainstay therapy for secondary prevention of sudden cardiac death is implantation of an implantable cardioverter defibrillator. Furthermore, revascularization and optimal medical therapy for heart failure and concurrent cardiovascular diseases should be ensured.

scholarly journals Dyspnoea at Term in an Obese Mother

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.

scholarly journals Clinical Profile of Patients with Heart Failure in Eastern Part of Nepal: a Hospital based study

2019 ◽  
Vol 8 (1) ◽  
pp. 48-52
Author(s):  
Abdul Khaliq Monib ◽  
Sahadeb Prasad Dhungana ◽  
Rajesh Nepal ◽  
Rinku Ghimire
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Angiotensin Receptor Blockers ◽  
Hypertensive Heart Disease ◽  
College Teaching ◽  
Clinical Profile ◽  
Female Ratio ◽  
Coronary Syndrome ◽  
Patients With Heart Failure ◽  
Receptor Blockers

Background: There is limited information on the clinical profile of patients with heart failure from the Nepalese population. Materials and Methods: This is a descriptive cross-sectional study on 120 consecutive patients with New York Heart Association class II or IV symptoms of heart failure admitted from June 2018 to January 2019 at Nobel Medical College Teaching hospital, Biratnagar, Nepal. Results: Mean age was 52.2 ± 20.6 years. The male and female ratio was 0.71. Ischemic cardiomyopathy, rheumatic heart disease, dilated cardiomyopathy, acute coronary syndrome, hypertensive heart disease, and peripartum cardiomyopathy were common etiologies constituting 22.5%, 19.1%,13.3%, 9.1%, 8.3 %, 5% of cases respectively. Among co-morbid conditions, anemia (91.6%),hypertension (31.6%), coronary artery disease (29.1%), diabetes (20.8%) and chronic kidney disease (11.6%) were common. Among various drugs used, 66.6% patients were prescribed diuretics, 60% mineral corticoid receptor blockers, 33.3% angiotensin-converting enzymeinhibitors, 33.3% beta-blockers, 29.1% digoxin and 8.3% angiotensin receptor blockers. Echocardiography revealed LV systolic and diastolic dysfunction in 75% and 25% respectively, mitral regurgitation in 52.5%, right ventricular dysfunction in 10.8 % and pulmonary artery hypertension in 66.6%. Conclusion: Appropriate use of evidence-based therapies, careful attention to the diagnosis and management of specific co-morbidities in patients with HF may help to improve outcomes.

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