Peripartum cardiomyopathy: case report

Abstract

Introduction; Péripartum cardiomyopathy (PPCM) is a disease of uncertain etiology, characterized by left ventricular systolic dysfunction and symptoms of heart failure, which occur in previously healthy women mainly during the end of pregnancy and the first 5 months after delivery. The incidence of PPCM is around 1 in 2500-4000 in the USA, 1 in 1000 in South Africa, and 1 in 300 in Haiti. Risk factors for PPCM include multiparty, advanced maternal age, twin pregnancy, Afro-American race etc. The precise cause and mechanism of PPCM remains unknown, but numerous hypotheses have been proposed (myocarditis, abnormal immune response to pregnancy, abnormal response to the hemodynamic stress of pregnancy, excessive prolactin production etc). The excessive prolactin production hypothesis represents a first potential disease-specific pathophysiological mechanism which offered bromocriptine as a potential novel therapeutic agent for treatment of PPCM patients. Purpose: Revealing the importance of early diagnosis and initiation of adequate treatment in patients with PPCM. Objectives: • Study of the incidence, risk factors, possible causes of PPCM; • Study of the clinical picture, evolution, new treatment strategies, prognosis of PPCM. Material and methods: literature review, data of various studies, retrospective analysis of patient’s chart and treatment sheet. Results: A 44-year-old woman was admitted to the department of Cardiology with following complaints: dyspnoea, chest discomfort, heart palpitation. Complaints ofdyspnoea, persistent cough and fatigue appeared about 3 years ago after Cesarean delivery of the second baby. Her treatment was not adequate about 2 years. She gave no history of any cardiac problems before. On examination, she was pale, slightly icteric, with nasolabial triangle cyanosis. There was oedema of low extremities. Her BP was 100/70 mm Hg, HR- 98 b/min, irregularly!! irregular. The cardiac auscultation showed gallop rhythm, significant cardiac murmurs. ECG: sinus tachycardia interrupted by polymorphic ventricular extrasistoles. Chest X-ray: venous stasis and increase in cardiac silhouette. Echo-CG showed dilatation of all chambers, ejection fraction-33%, there was mitral and tricuspid regurgitation (IV degree), severe pulmonary hypertension-75-80 mmHg. The laboratory investigations: increased liver tests. The final diagnosis was proposed: Postpartum cardiomyopathy. The patient was treated with diuretics, (3-blockers and ACEIetc. Conclusion: Péripartum cardiomyopathy is a relatively rare but a life-threatening form of heart failure. Heightened suspicion is important when a pregnant woman presents with signs of heart failure, because early diagnosis allows proven treatment to be started. Standard heart failure therapy should be started in postpartum patients with this disease, using available local protocols.