scholarly journals Kardiomiopati Peripartum: Manajemen Anestesi Terbaru

2021 ◽  
Vol 4 (1) ◽  
pp. 55-62
Author(s):  
Rafidya Indah Septica ◽  
Isngadi Isngadi
Keyword(s):  
Heart Failure ◽  
Systolic Dysfunction ◽  
Normal Pregnancy ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
High Morbidity ◽  
Regional Analgesia ◽  
Ventricular Ejection Fraction ◽  
Idiopathic Cardiomyopathy

Kardiomiopati peripartum (KMPP) atau Peripartum cardiomyopathy (PPCM) adalah kelainan jantung idiopatik dengan karakteristik disfungsi sistolik dan simptom gagal jantung pada akhir masa kehamilan atau beberapa bulan setelah kehamilan tanpa sebab lain yang mengancam jiwa maternal dengan risiko morbiditas dan mortalitas postpartum cukup tinggi. Penelitian terbaru dalam pemahaman tentang patofisiologi PPCM menunjukkan proses yang melibatkan faktor endotel dan faktor toksik kardio, seperti sFlt-1 dan 16 kDa prolaktin, sehingga kemampuan jantung beradaptasi terhadap kehamilan normal terlampaui pada ibu yang sudah rentan terhadap serangan jantung. Terapi spesifik PPCM belum dapat ditentukan. Bromokriptin yang bekerja memblok pelepasan prolaktin dari glandula pituitaria, pada beberapa penelitian awal menghasilkan perbaikan fraksi ejeksi ventrikel kiri secara bermakna. Penelitian lebih lanjut dengan jumlah sampel yang lebih besar masih harus dilakukan untuk terapi ini. Prinsip manajemen direkomendasikan sesuai dengan patofisiologi yang terjadi. Optimalisasi atau reduksi preload baik dengan reduksi natrium maupun cairan dan penggunaan diuretika, menurunkan afterload dengan vasodilator, dan memperbaiki kontraktilitas jantung dengan inotropik, dromotropik, atau inodilator adalah strategi utama yang direkomendasikan. Tidak ada perubahan strategi dalam manajemen terapi ini, tetapi pilihan teknik anestesi saat ini lebih berkembang ke analgesi/anestesi regional. Pemahaman penggunaan dosis dan konsentrasi anestetika lokal menjadi penting untuk mencapai target dalam strategi yang direkomendasikan.   Peripartum Cardiomyopathy: Update in Anesthesia Management Abstract Peripatum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricle systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause for heart failure is identified, life-threatening, and postpartum high morbidity and mortality risk. Recent studies in the understanding of PPCM pathophysiology indicate that there’s processes involving endothelial and cardio-toxic factors such as e.g. sFlt-1 and 16 kDa prolactin, leading the heart’s capacity to adapt to a normal pregnancy may be exceeded in some women already susceptible to cardiac insult. Spesific therapy for PPCM can not be determined. Bromocriptine that blocks the release of a hormone called prolactine from the pituitary gland in some preliminary studies improved left ventricular ejection fraction significantly. Further research with larger sample size remains to be done for this therapy. Management principles for PPCM are recommended in accordance with the pathophysiology. Depending on the volume status, preload has to be optimized by either fluid administration or sodium restriction and diuretics, decrease afterload using vasodilator, and improve contractility by using inotropic, dromotropic, or inodilator are the main strategies. There is no change in management strategy for PPCM, but regional analgesia/anesthesia preferably for now. Understanding the dose and concentration administration of local anesthethic drugs are important to achieve targets recommendation.

Peripartum Cardiomyopathy

2018 ◽  
Author(s):  
Kendra M Gray ◽  
Michael R Foley
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
The United States ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction

Peripartum cardiomyopathy (PPCM) is a serious and rare disease of late pregnancy or the early postpartum period. It is defined as idiopathic, nonfamilial, nongenetic, heart failure occurring in the absence of any other identifiable causes of heart disease within the last month of pregnancy or within the first 5 months postdelivery in otherwise previously healthy woman. The incidence in the United States is 1 per 3,000 to 4,000 live births. Left ventricular systolic dysfunction develops, almost always leading to a left ventricular ejection fraction of less than 45%. PPCM is unique in its rapid medical course and propensity to spontaneously resolve within 3 to 6 months of disease onset. The mortality rate is high, up to 10%, and the risk of relapse in subsequent pregnancies is also elevated. Treatment for PPCM varies slightly based on whether the woman is pregnant or postpartum. Conventional pharmacologic treatment includes diuretics, angiotensin-converting enzyme inhibitors (postpartum only), vasodilators such as hydralazine, digoxin, β-blockers, and anticoagulants. This review contains 5 figures, 5 tables, and 36 references. Key Words: critical care obstetrics, ejection fraction, heart failure, left ventricular systolic dysfunction, management, maternal mortality, peripartum cardiomyopathy, preeclampsia, pregnancy

scholarly journals Clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy: an ESC EORP registry

2020 ◽  
Vol 41 (39) ◽  
pp. 3787-3797 ◽  
Author(s):  
Karen Sliwa ◽  
Mark C Petrie ◽  
Peter van der Meer ◽  
Alexandre Mebazaa ◽  
Denise Hilfiker-Kleiner ◽  
...  
Keyword(s):  
Heart Failure ◽  
Middle East ◽  
Regional Variation ◽  
Clinical Presentation ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Asia Pacific ◽  
Left Ventricular Ejection ◽  
Myocardial Recovery ◽  
Ventricular Ejection Fraction

Abstract Aims  We sought to describe the clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy (PPCM) globally. Methods and results  In 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global registry on PPCM, under the auspices of the ESC EURObservational Research Programme. These societies were tasked with identifying centres who could participate in this registry. In low-income countries, e.g. Mozambique or Burkina Faso, where there are no national societies due to a shortage of cardiologists, we identified potential participants through abstracts and publications and encouraged participation into the study. Seven hundred and thirty-nine women were enrolled in 49 countries in Europe (33%), Africa (29%), Asia-Pacific (15%), and the Middle East (22%). Mean age was 31 ± 6 years, mean left ventricular ejection fraction (LVEF) was 31 ± 10%, and 10% had a previous pregnancy complicated by PPCM. Symptom-onset occurred most often within 1 month of delivery (44%). At diagnosis, 67% of patients had severe (NYHA III/IV) symptoms and 67% had a LVEF ≤35%. Fifteen percent received bromocriptine with significant regional variation (Europe 15%, Africa 26%, Asia-Pacific 8%, the Middle East 4%, P < 0.001). Follow-up was available for 598 (81%) women. Six-month mortality was 6% overall, lowest in Europe (4%), and highest in the Middle East (10%). Most deaths were due to heart failure (42%) or sudden (30%). Re-admission for any reason occurred in 10% (with just over half of these for heart failure) and thromboembolic events in 7%. Myocardial recovery (LVEF > 50%) occurred only in 46%, most commonly in Asia-Pacific (62%), and least commonly in the Middle East (25%). Neonatal death occurred in 5% with marked regional variation (Europe 2%, the Middle East 9%). Conclusion  Peripartum cardiomyopathy is a global disease, but clinical presentation and outcomes vary by region. Just under half of women experience myocardial recovery. Peripartum cardiomyopathy is a disease with substantial maternal and neonatal morbidity and mortality.

scholarly journals Using deep learning algorithms to simultaneously identify right and left ventricular dysfunction from the electrocardiogram.

2021 ◽  
Author(s):  
Akhil Vaid ◽  
Kipp W Johnson ◽  
Marcus A Badgeley ◽  
Sulaiman Somani ◽  
Mesude Bicak ◽  
...  
Keyword(s):  
Heart Failure ◽  
Deep Learning ◽  
Right Ventricular ◽  
Systolic Dysfunction ◽  
External Validation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Ventricular Ejection Fraction ◽  
Left And Right

Background Rapid evaluation of left and right ventricular function using deep learning (DL) on electrocardiograms (ECG) can assist diagnostic workflow. However, DL tools to estimate right ventricular (RV) function do not exist, while ones to estimate left ventricular (LV) function are restricted to quantification of very low LV function only. Objectives This study sought to develop deep learning models capable of comprehensively quantifying left and right ventricular dysfunction from ECG data in a large, diverse population. Methods A multi-center study was conducted with data from five New York City hospitals; four for internal testing and one serving as external validation. We created novel DL models to classify Left Ventricular Ejection Fraction (LVEF) into categories derived from the latest universal definition of heart failure, estimate LVEF through regression, and predict a composite outcome of either RV systolic dysfunction or RV dilation. Results We obtained echocardiogram LVEF estimates for 147,636 patients paired to 715,890 ECGs. We used Natural Language Processing (NLP) to extract RV size and systolic function information from 404,502 echocardiogram reports paired to 761,510 ECGs for 148,227 patients. For LVEF classification in internal testing, Area Under Curve (AUC) at detection of LVEF<=40%, 40%<LVEF<=50%, and LVEF>50% was 0.94 (95% CI:0.94-0.94), 0.82 (0.81-0.83), and 0.89 (0.89-0.89) respectively. For external validation, these results were 0.94 (0.94-0.95), 0.73 (0.72-0.74) and 0.87 (0.87-0.88). For regression, the mean absolute error was 5.84% (5.82-5.85) for internal testing, and 6.14% (6.13-6.16) in external validation. For prediction of the composite RV outcome, AUC was 0.84 (0.84-0.84) in both internal testing and external validation. Conclusions DL on ECG data can be utilized to create inexpensive screening, diagnostic, and predictive tools for both LV/RV dysfunction. Such tools may bridge the applicability of ECGs and echocardiography, and enable prioritization of patients for further interventions for either sided failure progressing to biventricular disease. Keywords Artificial Intelligence, Deep Learning, Machine Learning, HFrEF, Right Ventricular Dilation, Right Ventricular Systolic Dysfunction, echocardiography, electrocardiogram, ECG, EKG, LVEF, Left Ventricular Ejection Fraction, Left Heart Failure, Right Heart Failure

scholarly journals DYNAMIC CHANGES IN CARDIOVASCULAR RISK BIOMARKERS AND CYTOKINES OF MYOCARDITIS-FREE PATIENTS WITH DECOMPENSATED HEART FAILURE AND ISCHEMIC SYSTOLIC DYSFUNCTION

2021 ◽  
Vol 23 (4) ◽  
pp. 839-844
Author(s):  
O. N. Ogurkova ◽  
E. V. Kruchinkina ◽  
A. M. Gusakova ◽  
T. E. Suslova ◽  
V. V. Ryabov
Keyword(s):  
Heart Failure ◽  
Cardiovascular Risk ◽  
Ejection Fraction ◽  
Systolic Dysfunction ◽  
Decompensated Heart Failure ◽  
Interleukin 10 ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction

The development and progression of heart failure is associated with a variety of pathophysiological mechanisms, of particular interest is the study of the inflammatory response as a fundamental link in the pathogenesis of CHF and its main component – decompensation. An open, non-randomized, prospective study was carried out to evaluate the clinical and morphological features of subclinical inflammation in patients with acute decompensation of ischemic chronic heart failure with a reduced ejection fraction. The study included 25 patients with decompensated ischemic CHF with left ventricular ejection fraction < 40% aged 35 to 75 years (60.12±9.3 y. o.). In this study the dynamics of the serum content of C-reactive protein (CRP), N-terminal fragment of the brain natriuretic peptide precursor protein (NT-proBNP), soluble ST2(sST2), insulin-like growth factor-1 receptor (IGF-1R), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNFα) was performed by multiplex immunoassay using the FLEXMAP 3D. All studied patients were divided into two groups depending on the diagnosed myocarditis: patients with no signs of myocarditis and patients with myocarditis. It was found that in the group of patients with diagnosed myocarditis there was an increased content of CRP, IGF-1R, IL-6 and IL-10, TNFα compared to the group of patients without myocarditis. The median concentrations of the NT-proBNP and sST2 in both groups did not differ. At the follow-up visit a year later, there was a decrease in the content of CRP, NT-proBNP, IL-6 in both groups. In the group of patients with myocarditis, an increase in the content of sST2, IGF-1R, IL-10 was observed. Thus, the study carried out in dynamics revealed significant differences in the degree of changes in the serum activity of pro- and anti-inflammatory cytokines and biomarkers of cardiovascular risk in patients with decompensated heart failure with systolic dysfunction with diagnosed myocarditis and in its absence. 

scholarly journals Resynchronization in Heart Failure: What to choose?

2021 ◽  
Author(s):  
Mohammad El Baba ◽  
Moses Wananu ◽  
Marwan Refaat ◽  
Jayakumar Sahadevan
Keyword(s):  
Heart Failure ◽  
Biventricular Pacing ◽  
Nyha Class ◽  
Systolic Dysfunction ◽  
Severe Heart Failure ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Ventricular Ejection Fraction

Achieving Cardiac resynchronization therapy (CRT) with Biventricular pacing(BiVP) pacing for patients with moderate-to-severe heart failure (HF), left ventricular (LV) systolic dysfunction and ventricular dyssynchrony is well established and is currently the standard of care. Multiple studies have demonstrated significant improvement in quality of life, functional status, and exercise capacity in patients with New York Heart Association (NYHA) class III and IV heart failure who underwent resynchronization therapy1,2. In addition, resynchronization therapy is associated with survival benefit3. However, one third of patients do not respond to BIVP. New modalities for resynchronization have emerged namely His bundle pacing (HBP) and left ventricular septal pacing (LVSP). In this paper, we will review the benefits and limitations of BiVP and also the role of new pacing modalities such as HBP and LVSP in patients with HF with reduced left ventricular ejection fraction (LVEF) and electrical dysynchrony.

scholarly journals Peripartum Cardiomyopathy: A Review of Three Case Reports

2012 ◽  
Vol 4 (3) ◽  
pp. 164-166 ◽  
Author(s):  
Ankita Kumari ◽  
Mridul Chaturvedi
Keyword(s):  
Heart Failure ◽  
Left Ventricular Systolic Dysfunction ◽  
Case Reports ◽  
Systolic Dysfunction ◽  
Signs And Symptoms ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Idiopathic Cardiomyopathy ◽  
Maternal Morbidity And Mortality ◽  
Long Term Prognosis

ABSTRACT Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricular systolic dysfunction toward the end of pregnancy or in the months after delivery. Incidence of PPCM ranges from 1:300 to 1:15,000 pregnancies. Causes and pathogenesis are poorly understood. Clinical presentation includes signs and symptoms of heart failure. PPCM remains a major cause of maternal morbidity and mortality. Many cases of PPCM improve or resolve completely but others progress to heart failure; as early diagnosis and medical treatment may affect the patient's long-term prognosis. The aim of this report is to make health professionals aware of the possibilities in a woman with dyspnoea in the postpartum period. How to cite this article Kumari A, Singh S, Singh S, Chaturvedi M. Peripartum Cardiomyopathy: A Review of Three Case Reports. J South Asian Feder Obst Gynae 2012;4(3):164-166.

Abstract 237: Breastfeeding is Not Associated With Worse Outcomes for Women With Peripartum Cardiomyopathy

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Kris Kawamoto ◽  
Elizabeth Langen ◽  
Elizabeth A Jackson ◽  
Melinda Davis
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
University Of Michigan ◽  
Absolute Contraindication ◽  
Ventricular Ejection Fraction ◽  
Expert Opinions ◽  
The University ◽  
Survey Questionnaires

Background: Women diagnosed with peripartum cardiomyopathy (PPCM) are frequently advised not to breastfeed their infants because of concern that the nursing hormone prolactin drives the pathogenesis of PPCM. However, this remains controversial. We sought to determine whether women with PPCM who breastfed had lower rates of recovery. Methods: Patients with PPCM at the University of Michigan (2000-2011) were retrospectively reviewed. Demographics, clinical data, and outcomes were collected. Questionnaires requesting information about breastfeeding status and duration were mailed to women with PPCM. This data was correlated with recovery status, defined as left ventricular ejection fraction ≥ 50% at 1 year after diagnosis. Results: Of 27 women with PPCM with known breastfeeding status, 13 women breastfed (48%) and 14 did not (52%). Among women who breastfed, 8 recovered (62%) and 5 did not (38%). Among women who did not breastfeed, 11 recovered (79%) and 3 did not (21%). This was not statistically different (p=0.29). There were no significant differences between breastfeeding and non-breastfeeding women related to their mean age or treatment with heart failure medications. Of the 16 patients who completed additional survey questionnaires, 11 (69%) reported their physician had instructed them not to breastfeed. Conclusions: Contrary to some expert opinions, breastfeeding was not associated with lack of recovery. While larger prospective studies are needed to clarify this conclusion, it appears that a diagnosis of PPCM should not be an absolute contraindication to breastfeeding.

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