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.

scholarly journals A Change of Heart: Case Series of Peripartum Cardiomyopathy

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Sean Martin ◽  
Daniel Short ◽  
Chih Mun Wong ◽  
Dina McLellan
Keyword(s):  
Heart Failure ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Significant Proportion ◽  
Case Series ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Ventricular Systolic Dysfunction ◽  
Diagnostic Challenge

Peripartum cardiomyopathy (PPCM) is an uncommon disease of pregnancy, occurring in about 1 in 2000 live births, and is characterized by the development of heart failure, due to left ventricular systolic dysfunction. It is associated with high rates of maternal and neonatal mortality. Cardiac disease is the leading cause of maternal death in the UK: PPCM accounts for about 17% of these. Clinical findings of decompensated heart failure (HF) are often masked by the normal physiological changes seen in pregnancy making the diagnosis challenging. A high index of suspicion is essential—prompting referral for echocardiogram, which is crucial for diagnosis. Favourable prognosis is dependent on the early initiation of HF medications. Although full recovery occurs in around half of cases, left ventricular systolic dysfunction persists in a significant proportion of patients with PPCM and the risk of recurrence in subsequent pregnancies is high. The pathophysiology of PPCM is under intense research. We present four patients with PPCM and a review of the literature. Owing to the diagnostic challenge of PPCM and decompensated HF in pregnant mothers and its high mortality rate without treatment, prompt investigation and referral are key to improving maternal survival.

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.

scholarly journals Peripartum Cardiomyopathy

2014 ◽  
Vol 25 (2) ◽  
pp. 96-98
Author(s):  
Md Abdul Mahid Khan ◽  
Hasina Banoo ◽  
Sheikh Salahuddin Ahmed
Keyword(s):  
Left Ventricular Systolic Dysfunction ◽  
Post Partum ◽  
Systolic Dysfunction ◽  
Normal Pregnancy ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Ventricular Systolic Dysfunction ◽  
Idiopathic Cardiomyopathy ◽  
Medicine Today ◽  
High Degree

Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricular systolic dysfunction. Onset is from the last trimester of pregnancy to 5 months postpartum. Diagnosis in the last trimester is complicated by the fact that the early symptoms of this disorder may mimic the symptoms of normal pregnancy. However, it is essential for the practitioner dealing with such population to have a high degree of clinical suspicion for early diagnosis and management. Echocardiography is used to diagnose this entity and monitor the therapy. We present a case report of a 40-year-old woman who presented two days post-partum with respiratory distress and early echocardiography helped in diagnosing PPCM. The aim of this report is to make health professionals aware of the possibilities of PPCM in a woman with dyspnoea in the postpartum period. DOI: http://dx.doi.org/10.3329/medtoday.v25i2.17930 Medicine Today 2013 Vol.25(2): 96-98

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 Cross sectional study estimating prevalence of heart failure and left ventricular systolic dysfunction in community patients at risk

Heart ◽  
2001 ◽  
Vol 86 (2) ◽  
pp. 172-178 ◽  
Author(s):  
O W Nielsen ◽  
J Hilden ◽  
C T Larsen ◽  
J F Hansen
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
General Practice ◽  
Heart Disease ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Cross Sectional ◽  
General Practices

OBJECTIVETo examine a general practice population to measure the prevalence of signs and symptoms of heart failure (SSHF) and left ventricular systolic dysfunction (LVSD).DESIGNCross sectional screening study in three general practices followed by echocardiography.SETTING AND PATIENTSAll patients ⩾ 50 years in two general practices and ⩾ 40 years in one general practice were screened by case record reviews and questionnaires (n = 2158), to identify subjects with some evidence of heart disease. Among these, subjects were sought who had SSHF (n = 115). Of 357 subjects with evidence of heart disease, 252 were eligible for examination, and 126 underwent further cardiological assessment, including 43 with SSHF.MAIN OUTCOME MEASURESPrevalence of SSHF as defined by a modified Boston index, LVSD defined as an indirectly measured left ventricular ejection fraction ⩽ 0.45, and numbers of subjects needing an echocardiogram to detect one case with LVSD.RESULTSSSHF afflicted 0.5% of quadragenarians and rose to 11.7% of octogenarians. Two thirds were handled in primary care only. At ⩾ 50 years of age 6.4% had SSHF, 2.9% had LVSD, and 1.9% (95% confidence interval 1.3% to 2.5%) had both. To detect one case with LVSD in primary care, 14 patients with evidence of heart disease without SSHF and 5.5 patients with SSHF had to be examined.CONCLUSIONSSHF is extremely prevalent in the community, especially in primary care, but more than two thirds do not have LVSD. The number of subjects with some evidence of heart disease needing an echocardiogram to detect one case of LVSD is 14.

scholarly journals Central and obstructive apneas prevalence in heart failure with reduced, mid-range and preserved ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Borrelli ◽  
P Sciarrone ◽  
F Gentile ◽  
N Ghionzoli ◽  
G Mirizzi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Cardiopulmonary Exercise Testing ◽  
Left Ventricular ◽  
Apnea Hypopnea Index ◽  
Preserved Ejection Fraction ◽  
2D Echocardiography

Abstract Background Central apneas (CA) and obstructive apneas (OA) are highly prevalent in heart failure (HF) both with reduced and preserved systolic function. However, a comprehensive evaluation of apnea prevalence across HF according to ejection fraction (i.e HF with patients with reduced, mid-range and preserved ejection fraction- HFrEf, HFmrEF and HFpEF, respectively) throughout the 24 hours has never been done before. Materials and methods 700 HF patients were prospectively enrolled and then divided according to left ventricular EF (408 HFrEF, 117 HFmrEF, 175 HFpEF). All patients underwent a thorough evaluation including: 2D echocardiography; 24-h Holter-ECG monitoring; cardiopulmonary exercise testing; neuro-hormonal assessment and 24-h cardiorespiratory monitoring. Results In the whole population, prevalence of normal breathing (NB), CA and OA at daytime was 40%, 51%, and 9%, respectively, while at nighttime 15%, 55%, and 30%, respectively. When stratified according to left ventricular EF, CA prevalence decreased from HFrEF to HFmrEF and HFpEF: (daytime CA: 57% vs. 43% vs. 42%, respectively, p=0.001; nighttime CA: 66% vs. 48% vs. 34%, respectively, p<0.0001), while OA prevalence increased (daytime OA: 5% vs. 8% vs. 18%, respectively, p<0.0001; nighttime OA: 20 vs. 29 vs. 53%, respectively, p<0.0001). When assessing moderte-severe apneas, defined with an apnea/hypopnea index >15 events/hour, prevalence of CA was again higher in HFrEF than HFmrEF and HFpEF both at daytime (daytime moderate-severe CA: 28% vs. 19% and 23%, respectively, p<0.05) and at nighttime (nighttime moderate-severe CA: 50% vs. 39% and 28%, respectively, p<0.05). Conversely, moderate-severe OA decreased from HFrEF to HFmrEF to HFpEF both at daytime (daytime moderate-severe OA: 1% vs. 3% and 8%, respectively, p<0.05) and nighttime (noghttime moderate-severe OA: 10% vs. 11% and 30%, respectively, p<0.05). Conclusions Daytime and nighttime apneas, both central and obstructive in nature, are highly prevalent in HF regardless of EF. Across the whole spectrum of HF, CA prevalence increases and OA decreases as left ventricular systolic dysfunction progresses, both during daytime and nighttime. Funding Acknowledgement Type of funding source: None

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